Digestive System Diseases And Nursing Care PDF

NURS402 GRADUATION INTERNSHIP ASST. PROF. DR. UFUK KAYA 2024-2025 FALL TERM Digestive System Diseases and Nursing Care 2 ORAL CAVITY AND SALIVARY GLAND DISEASES 3  Acute Ulcers They are short- term and painful l...

NURS402 GRADUATION INTERNSHIP ASST. PROF. DR. UFUK KAYA 2024-2025 FALL TERM Digestive System Diseases and Nursing Care 2 ORAL CAVITY AND SALIVARY GLAND DISEASES 3  Acute Ulcers They are short- term and painful lesions caused by traumas, immunological causes and infections. The most common areas are the tongue, cheeks and lips. Acute ulcers can be 4  Aphthous Ulcers They are painful, erythematous surrounding, pale middle ulcers. Lesions may be singular or aggregated. Mouthwashes with lidocaine and steroid therapy provide symptomatic 5  Viral Infections-01 Primary acute gingivitis usually develops due to the herpes simplex virus that affects the lips and oral mucosa. Lesions quickly turn into painful ulcers. Acute gingivitis causes weakness, bad breath and lymphodenopathy in the neck. Complaints heal spontaneously within 10-14 days. Oral acyclovir, solutions to reduce pain and discomfort may be recommended. In 6 7  Viral Infections-02 Oral lesions due to chickenpox are usually associated with skin lesions. It goes away on its own within two weeks. In Herpes Zoster, lesions are found on the cheek, tongue, and palate, and unilateral lesions are typical. Lesions are usually painful and often go away on their own. 8  Viral Infections-03 Epstein-Barr virus causes malaise, sore throat, mild fever, cervical lymphadenopathy, gingival hemorrhages, and diffuse petechiae of the palate. Lesions heal spontaneously. HIV infection also causes gingivitis. 9  Bacterial and Fungal Infections-01 Acute Necrotizing Gingivitis (Vincent's Angina): These are lesions of the gums characterized by painful, edematous, ulceration and necrosis foci. Spicy and acidic foods are avoided, mouthwashes can be recommended for symptomatic and hygienic purposes, alcohol should not be consumed, smoking is not recommended, and it is treated with broad-spectrum antibiotics. 10  Bacterial and Fungal Infections-02 Oral infections are common due to syphilis. Its specific treatment is penicillin crystallized. In tuberculosis, ulcers are seen in the form of lesions with irregular edges on the tongue, tonsils and soft palate. Fungal infections are lesions in the form of white dots anywhere on the oral mucosa. Antifungal solutions or tablets are recommended for treatment. 11  Neoplastic Diseases Squamous cell cancer is two times more common in men than women. Tobacco use in etiology is around 80%. In order of frequency, it is seen on the tongue, lips, oropharynx and floor of the mouth. It usually starts as a red macule, then evolves from the mucous membrane into pitted, hard, and chronic ulcers. 12  Nursing Diagnoses in Oral Diseases 'Oral mucosal change' due to infection, mechanical or chemical reasons; 'Changes in nutrition/malnutrition' due to nutrition less than the organism's needs and inability to digest nutrients related to oral or dental problems; 'Anxiety/fear of social isolation' due to diseases, change in appearance, pain; ‘Shaking of body consciousness' due to change in appearance; ‘Pain' due to oral lesion or treatment; 'Lack of verbal communication' due to treatment; ‘Risk of infection' due to disease or treatment; 13  Main Purpose of Care Improving the condition of the oral mucous membrane, improving food intake, providing a positive body image, reducing pain, establishing communication, preventing infections, and providing the patient with information about the disease and treatment. 14  Health Education Topics Providing a balanced diet and adequate hydration Correct and regular oral hygiene Brushing teeth twice a day with a soft brush Brushing teeth with a brush at a 45- degree angle between teeth and gums Using an anti-plaque solution No alcohol and smoking General oral and dental check-ups regularly every 6 months Seeing a doctor for lesions in the mouth that do not heal in two weeks 15 ESOPHAGUS DISEASES 16  Common Symptoms-01 Dysphagia: Difficulty or discomfort when swallowing, a feeling of stuck somewhere behind the sternum. Odynophagia: Pain with difficulty in swallowing. Pyrosis: It is a finding that is perceived more than pain. It passes with antacids. 17  Common Symptoms-02 Regurgitation: It is the passing of gastric juice and its contents into the mouth without nausea. Rumination: Re-swallowing the material in the mouth. Esophageal Colic: In addition to the discomfort associated with severe reflux, excessive motor activity in the esophageal muscles causes severe pain. 18  Common Symptoms-03 Hematemesis: Vomiting blood. Halitosis: It is bad breath. Sialorrhea: It is an increase in saliva secretion as a reflex. 19  Achalasia-01 The cardio esophageal sphincter cannot relax completely and there are no peristaltic movements in the lower 2/3 of the esophagus. It is seen between the ages of 25-60 and equally between men and women. It is a chronic, progressive disease of unknown cause. 20  Achalasia-02 Symptoms include difficulty in swallowing, feeling of obstruction in the lower part of the esophagus, retrosternal pain, pyrosis, and pulmonary complications. In treatment, it is recommended to eat slowly and take fluids. Pneumatic dilation is applied. The procedure is painful. Therefore, before the procedure, the patient should be given analgesics or tranquilizers. There is a risk of perforation in the procedure. 21 22 23  Scleroderma It is a connective tissue disease with extensive esophageal involvement. It is a condition in which peristaltic movements are absent and irregular contractions are seen. 24  Common Spasm It is a motor dysfunction of the esophagus. Patients are usually around the age of 40, it is more common in women. There is painful and difficult swallowing Diagnosis is made by taking a barium film. There is no specific treatment, it is recommended to eat little and often. Dilation and esophagomyotomy can be performed. Diffuse esophageal spasm may 25 Gastroesophageal Reflux-01 They are acute and chronic inflammatory changes that develop due to the regurgitation of unruly stomach contents or alkaline small intestinal secretion into the esophagus. The most common causes are hydrochloric acid and pepsin. It is usually seen in the postprandial supine position. 26 Gastroesophageal Reflux-02 Symptoms: There are signs such as burning, dysphagia, odynophagia, regurgitation, belching and bitter-sour taste felt along the breastbone. Diagnosis is made by endoscopy, barium film or scintigraphy with technicium. Complications: It can cause esophageal stricture, esophageal ulcer, pulmonary aspiration, upper gastrointestinal system bleeding and 27 Gastroesophageal Reflux-03 Treatment and Care The stomach should not be filled too much, it should be eaten little by little and often. Head of bed should be raised Do not eat or drink anything within 2-3 hours before going to bed. Avoid fatty, sour and spicy foods Avoid smoking and alcohol Excess weight should be lost Antacids should be taken after meals and just before bedtime. H2 receptor blockers should be given as medical treatment. 28 Gastroesophageal Reflux-04 Risk Factors Obesity Overweight Pregnancy Smoking Chewing tobacco High fat diet Theophylline, High estrogen and caffeine, chocolate progesterone levels 29 Gastroesophageal Reflux-05 Nursing Diagnosis 'Feeding more than body needs' due to dysphagia Lack of knowledge Pain Aspiration risk 30 Gastroesophageal Reflux-06 Purpose of Care It is to ensure that the patient is adequately fed, to reach her/his ideal weight, to relieve pain, to prevent complications and to complete the lack of knowledge. 31 Gastroesophageal Reflux-06 Nursing Interventions Ensuring the patient uses the recommended antacids. To raise awareness of the patient's eating habits and post-meal applications. Explaining to the patient what to eat and what not to eat. Planning and implementing health education and disease-related education for the patient Taking small bites, careful chewing and semi-fowler position to avoid the risk of 32 33  Esophageal Varices Varicose veins, which develop due to conditions that cause an increase in portal pressure, do not usually give any symptoms. It occurs with bleeding due to conditions that cause the valsalva maneuver such as vomiting, coughing, snoring, or due to poorly chewed hard foods tearing ulcerated or swollen varicose veins. It is very serious and requires immediate treatment. 34 35  Diverticulum They are formations that contain one or more layers of the esophageal wall. It is seen with symptoms such as a feeling of fullness in the neck, difficulty in swallowing and regurgitation. 36  Chemical Burns-01 It is the formation of burns in the esophageal mucosa due to accidentally or intentionally ingested chemicals. The form of emergency intervention is determined according to the severity of the burn. The patient is immediately given an IV line, nothing is given by mouth. 37  Chemical Burns-02 A nasogastric tube is inserted to prevent re-contact of the esophagus with the toxic substance during vomiting. Steroids and antibiotics can be started as a prophylactic to prevent scar tissue and inflammation. The antidote of the smoked substance can be drunk. Dilatation therapy is applied to prevent scar tissue development after emergency application. 38  Foreign Bodies: Insertion of foreign bodies such as fish bones, needles, and teeth into the esophagus causes dysphagia and pain. After the object is visualized, it is treated endoscopically or surgically. Mallory-Weiss Syndrome: It is a severe condition with ruptures in the cardiac mucosa due to recurrent persistent vomiting. 39 STOMACH DISEASES 40  Gastritis-01 It is inflammation of the gastric mucosa. There are three classifications of erosive or hemorrhagic gastric, non-erosive gastritis and specific gastric. Symptoms: Abdominal discomfort, headache, nausea, anorexia, vomiting, wheezing can be seen in sudden gastritis. Vitamin B12 deficiency in chronic gastritis may cause loss of appetite, burning sensation after meals, nausea, vomiting, belching and a sour taste in the mouth. Diagnosis: X-ray, endoscopy, urease test/blowing test 41  Gastritis-02 Treatment: The basic approach in treatment is for the cause. Foods and beverages that increase the symptoms are avoided, if the patient can take it orally, a non-irritating diet is recommended, if he/she cannot take enough fluid, parenteral fluid is given. If gastritis has developed with acid or alkali, neutralizing treatment is applied. Antacid against acid, lemon juice against alkali or diluted vinegar can be given. As a general precaution, the patient is taken to bed rest, analgesics and sedatives can be given. If helicobacter pylori is detected in the etiology, tetracycline or amoxicillin are given as antibiotics. Intrinsic factor deficiency42 is  Gastritis-03 Nursing Diagnosis 'Anxiety' due to treatment 'Change in diet - less nutrition than body requirement' due to malnutrition 'Risk of fluid deficiency' due to vomiting and not getting enough 'Pain' due to gastric acid and inflammation 'Lack of knowledge' about his disease, treatment, symptoms and possible complications 'Risk of disruption of tissue integrity: gastrointestinal bleeding' 43  Gastritis-04 Aim of the Care To reduce the patient's anxiety, to avoid irritating foods, to provide adequate nutrition and fluid balance, to evaluate the daily pain with the pain scale and to ensure that the patient experiences less pain by arranging the treatment, and to enable the patient to express what he or she knows. 44  Gastritis-05 Nursing Interventions Assess and monitor pain, reduce it Giving medications as recommended Monitoring the effects and side effects of drugs assessing the development of symptoms Taking initiatives to reduce anxiety Following the recommended diet Provide education on lifestyle adjustments Providing education on medicines Providing support and education about smoking and alcohol To discuss dietary practices, to ensure adequate nutrition Avoiding antacids containing sodium 45and 46  Peptic Ulcer-01 It is the loss of tissue beyond the muscular mucosa that occurs in the stomach, duodenum or esophagus. A peptic ulcer is called 'gastric ulcer' if it develops in the stomach, 'duodenal ulcer' if it develops in the duodenum, and 'esophageal ulcer' if it develops in the esophagus. 47  Peptic Ulcer-02 Today, the most important known factors in peptic ulcer are NSAIDs, smoking and helicobacter pylori. Symptoms: While most ulcer patients complain of mild indigestion, others do not have any complaints. Some patients feel burning in the upper abdomen or hunger 1- 3 hours after meals or later in the night. 48  Peptic Ulcer-03 Diagnosis: The diagnosis of ulcer is made either by barium radiography of the upper gastrointestinal tract or by an endoscopy method called esophageal gastroduodenoscopy. Endoscopy is a method that provides more reliable information. Complications: Bleeding, perforation and gastric obstruction. 49  Peptic Ulcer-04 Purpose of Treatment: Relieve pain Promote ulcer healing Prevent disease recurrence To ensure that the side effects of the disease are minimal It is to ensure the patient's compliance with the disease and treatment and to ensure adequate nutrition. 50  Peptic Ulcer-05 Treatment: It is considered more appropriate to exclude foods that touch the person from the diet. Complete cessation of alcohol in the acute phase is considered appropriate. Coffee is not recommended as it stimulates acid secretion. It should not be smoked because the effect of smoking and the fact that it causes relapses become certain. Complete discontinuation of aspirin and NSAIDs is recommended. 51  Peptic Ulcer-06 Medication: Antacids H2 receptor antagonists Anticholinergic and antimuscarinic drugs Proton pump inhibitors Antibiotics and bismuth salts 52 INTESTINAL DISEASES 53 Irritable Bowel Syndrome-01 It is the most common motility problem of the colon. Irritable bowel syndrome is a disease that includes periods of persistent or recurrent abdominal pain and changes in defecation habits, periods of diarrhea or constipation. The main problem in the disease is the excessive response of the gastrointestinal system to stimuli. 54 Irritable Bowel Syndrome-02 Symptoms: Pain: Abdominal pain and discomfort that eases or goes away with crampy defecation Pain with change in stool frequency and consistency Defecation Change: Change in stool frequency Stools in different shapes such as hard, soft, watery Change in defecation (difficulty, urgent defecation, inability to relax after defecation) Mucus defecation 55 Irritable Bowel Syndrome-03 Treatment and Care: The basic approach is symptomatic. Diet regulation, administration of antispasmodics, preference for fibrous foods, not drinking beverages such as coffee-tea-cola, drinking plenty of fluids, regular defecation habit, drinking warm water, going to the toilet at the same time every day, not delaying when defecation is needed, eating slowly to prevent excessive gas eating, not consuming touched foods and carbonated drinks, not chewing gum, coping with stress, psychotherapy, hypnosis, behavioral therapy. 56 57 Inflammatory Bowel Diseases 1. Colitis Ulcerosa 2. Crohn's Disease. 58  Colitis Ulcerosa (Ulcerative Colitis) Acute, superficial lesions involving the colon are limited to the anus.. The etiology of the disease is unknown. Complications: Perforation and malignancy risk. Symptoms: The prominent symptoms are rectal bleeding, diarrhea, fever, weight loss and abdominal pain. Treatment: Drugs that control symptoms such as sulfasalazine, pyridine- acetylsalicylic acid derivatives, antibacterial corticosteroids and 59 60  Crohn’s Disease (Regional Enteritis) It occurs in a region of the gastrointestinal tract from the mouth to the anus. The etiology of the disease is unknown. Symptoms: It has a milder onset than ulcerative colitis. Pain in the form of diarrhea and colic accompanying regional obstruction and sometimes a palpable mass in the right lower quadrant may be detected. Treatment: The first line of treatment is corticosteroids. The intestines are rested by feeding with mild hyperalimentation. Complication: Malabsorption. Most Crohn's patients die from bleeding and sepsis. 61 62  Ischemic Colitis It is an ischemia- related picture seen in elderly patients due to progressive atherosclerosis. Symptoms: Acute ischemia is accompanied by localized abdominal pain, tenderness, rectal bleeding, fever, and hypotension. 63  Diverticulitis-01 Colon diverticulum is small pocket- shaped formations covered with serosa containing mucosa. It is mostly seen in the sigmoid colon. Symptoms: Similar to appendicitis. Complication: Bleeding and abscess. 64  Diverticulitis-02 Nursing Diagnoses Acute 'pain' due to diverticulitis 'Risk of infection' due to abscess formation and perforation 'Anxiety' due to unknowns Purpose: To reduce the patient's pain, abscess and perforation risk and anxiety. 65  Diverticulitis-03 Nursing Interventions The patient is allowed to rest during the painful period. Antibiotics and analgesics are given as indicated. Vital signs and pain are evaluated every 4 hours. Abdominal tenderness is evaluated every 4 hours. The patient is warned to inform the nurse in case of shallow breathing and increased pain. The patient's anxiety is reduced by 66 Nursing Diagnoses in Chronic Inflammatory Diseases 'Diarrhea' due to inflammatory process ‘Pain' due to the inflammatory process 'Fluid volume deficiency' due to anorexia, nausea, vomiting 'Underfeed' due to dietary restrictions, malabsorption and nausea 'Activity intolerance' 'Anxiety' 'Inadequate individual coping' due to recurrent episodes of diarrhea 'Risk of compromised skin integrity' due to malnutrition and diarrhea 'Lack of knowledge and risk of ineffective 67  Nursing Interventions in Chronic Inflammatory Diseases-01 Purpose: To ensure the patient's normal intestinal elimination, to reduce abdominal pain and cramps, to prevent fluid-electrolyte deficiency, to maintain ideal body weight, to reduce fatigue, to reduce anxiety, to improve effective coping, to protect skin integrity, to prevent complications. 68  Nursing Interventions in Chronic Inflammatory Diseases-02 Applying pharmacological and non- pharmacological methods to reduce pain Ensuring adequate fluid intake Monitor skin turgor Providing adequate nutrition Providing adequate rest Doing anxiety-reducing apps Making applications to protect the skin 69  Whipple's Disease It is a lymphatic system disease seen in the small intestines in the gastrointestinal tract, which is usually seen in men and progresses with severe weight loss, abdominal pain, arthritis, fever, peripheral lymphadenopathy, anemia. If left untreated, it results in death. Large-spectrum antibiotics are used for treatment. 70 71  Hemorrhoids-01 It is a very common problem that occurs with the enlargement of the veins in the anorectal region. Symptoms: Pain, bleeding, and palpation of external hemorrhoids are 72 73  Hemorrhoids-02 Treatment and Care First of all, applications are made to prevent the symptoms of hemorrhoids. Treatment includes local treatment and dietary practices. Cold application is applied for 3-4 hours to relieve pain, followed by hot sitz bath 3-4 times a day, this application is useful to relieve discomfort, especially in thrombosed hemorrhoids. Local anesthetics can be used for pain. 74  Hemorrhoids-03 Treatment and Care If there is inflammation, steroid pomades may be recommended. A high-fiber diet and fluid intake are recommended to ensure regular emptying of the intestines. It is recommended to avoid hot and spicy foods and alcohol. In these applications, if the symptoms do not improve in 3-5 days or if they recur frequently, surgery is decided. 75 INFECTIOUS DISEASES OF THE INTESTINES 76  Amoebic Dysentery (Amebiasis) It is an infection caused by Entomoeba Histolytica, seen in warm countries and transmitted by contaminated food. It has symptoms such as bloody-mucous diarrhea, abdominal pain, fever, nausea and vomiting. In treatment, drugs effective against amoeba (chloraquine, emetine tetracycline) are used. The patient is informed about hygiene- food hygiene, maintaining fluid-electrolyte balance, regular drug use, and disease- treatment. 77 78  Bacillary Dysentery The causative agent of the disease is shigella. The infection is spread through water, the environment, and contaminated food. After a few hours or 3 days of incubation, sudden abdominal pain, diarrhea, vomiting, fever, and weakness are seen. Appropriate antibiotic therapy and symptomatic treatment are applied. Fluid-electrolyte balance is maintained and the patient is isolated. 79 80  Typhoid Sickle is an infection transmitted by the fecal route. Symptoms: Increasing fever, spleen enlargement, leukopenia and skin rashes are seen. Chloramphenicol is used in the treatment. The loss of fluid is replaced, a liquid and soft diet is applied, if the patient cannot take it orally, it is fed by IV route. These patients should not be given enemas. Otherwise, perforation may develop. 81 82  Food Poisoning It is an acute disease picture caused by contaminated food. Bacteria causing poisoning include staphylococcus aureus, clostridium perfingens type A, vibrio parahaemolyticus, compylobacter jejuni, yesinia enterocolitica, shigella, botulism. 83  Cholera It is a serious infection transmitted by vibrio-cholerea. It is transmitted by infected waters and causes epidemics in autumn and summer. The incubation period after infection is up to 5 days. The picture that starts with mild vomiting continues with diarrhea, stool is in the form of rice sensation. Shock may develop due to severe fluid loss. Compensation of fluid loss is treated with tetracyclines, chloramphenicole, erythromycine effective against cholera84 85 86 PANCREATITIS 87  Acute Pancreatitis-01 It is a picture of edema, self- digestion, necrosis and, in some cases, bleeding. The most common causes of acute pancreatitis are alcoholism and gallstones. It is often seen in the age of 60-70 years. Alcohol-induced pancreatitis is more common in men, while pancreatitis due to biliary tract diseases and stones is more 88  Acute Pancreatitis-02 Etiology Stone, tumor, spasm, Metabolic factors such edema, parasitic, as liver disease, diverticulum and hyperlipidemia, duodenal pathologies diabetes, of the bile or hypercalcemia pancreatic duct Medicines such as Hormonal factors thiazide, furosemide, procainamide, tetracycline and sulfonamide Toxic agents and Traumas, infections 89 90 91  Acute Pancreatitis-03 Symptoms It starts with severe pain, nausea and vomiting that wakes you up in the middle of the night. Pain is felt in the epigastric region, in the left upper quadrant, and is usually continuous. There is ileus, high fever, confusion and tachycardia. The most important finding in the diagnosis is the rapid increase in serum amylase level. Serum lipase level also rises and remains 92  Acute Pancreatitis-04 Symptoms Leukocytes and liver enzymes are elevated, there is hypocalcemia and hypertriglyceridemia. Depending on the tissue damage, fever of 38-39 degrees, in severe cases, weakness, palpitations, cold sweats, acceleration in the pulse, a decrease in blood pressure and shock develops. In 30-50% of the patients, blood sugar is initially elevated, calcium is the most altered among blood electrolytes, and hypocalcemia 93 Acute Pancreatitis-05 Complications Shock (hypotensive, septic, hemorrhagic) Pulmonary insufficiency (ARD) atelectasis Kidney failure Metabolic disorders (hypocalcemia, acidosis) Abscess Necrosis Portal and splenic vein thrombosis Bleeding (into and around the pancreas) 94  Acute Pancreatitis-06 Nursing Diagnoses 'Pain' due to inflammation of the pancreas and surrounding tissue, obstruction of the gallbladder tracts and pancreatic ducts, and impaired blood circulation 'Fear and anxiety' due to change in health status and pain 'Respiratory change-insufficient breathing' due to ascites, pain, abdominal tension 'Change in nutrition, undernutrition' due to nausea-vomiting and nasogastric decompression 95  Acute Pancreatitis-07 Nursing Diagnoses 'Lack of knowledge' on pancreatitis treatment and complications 'Risk of injury-damage' due to loss of endocrine and exocrine functions of the pancreas due to pancreatic suction Individual 'ineffective coping' with alcohol addiction 96  Acute Pancreatitis-08 Nursing Interventions Meperidine is preferred to relieve pain and non- pharmacological methods are used. The volume imbalance needs to be corrected and monitored. Nasogastric aspiration is applied to rest the pancreas. If necessary, antacids and anticholinergics can be given. Oral nutrition is stopped and parenteral nutrition is started. After the acute picture resolves, the patient is started on a low-fat, caffeine-free diet that will not stimulate gastric secretion. Antibiotics are given to prevent infection. 97  Acute Pancreatitis-09 Nursing Interventions Insulin is given IV according to the blood sugar level. A central venous catheter is inserted into the patient, and central venous pressure and urine monitoring are performed. All applications are explained and the patient is allowed to ask questions and anxiety and fear are relieved. Peritoneal dialysis is applied in patients whose general condition deteriorates. If the patient has conditions that require surgical intervention, surgical treatment is applied. 98  Acute Pancreatitis-10 Nursing Interventions Patients are usually on bed rest. Therefore, care is taken against complications (such as pressure sores) that may develop. There is respiratory failure due to limitation of movement, pain and ascites. For this purpose, the patient's lungs are evaluated and respiratory hygiene practices are performed. Applications are made for reasons limiting breathing. Patient education is provided on the subjects that are needed. The patient has signs of endocrine system dysfunction such as hyperglycemia, fatty stool, and diarrhea. If diabetes has developed, 99  Chronic Pancreatitis-01 It is a disease of the pancreas characterized by continuous inflammation, fibrosis, dilatation of the pancreatic ducts and tissue damage. It occurs equally in all ages and in both sexes. Etiology: Chronic pancreatitis may develop due to alcohol, nutrition, trauma and metabolic diseases, genetic causes, and benign or malignant obstructions. 100  Chronic Pancreatitis-02 Symptoms: Pain. The pain radiates to the epigastric region and to the lower back on both sides. Excessive weight loss, malabsorption and jaundice due to diabetes mellitus and occlusions are seen. Diagnosis: Stool fat examination, secretin test, blood glucose, glucose tolerance test, direct abdominal film, USG, CT, NMR and endoscopic retrograde cholangiopancreatography are applied. 101  Chronic Pancreatitis-03 Treatment and Care: Purpose: To control pain, to control endocrine insufficiency, to treat exocrine insufficiency. Non-addictive analgesics are given primarily to relieve pain. When it is not enough, it is switched to narcotic analgesics. Abdominal pain can be reduced by administering high doses of additional pancreatic enzymes. The etiological cause is treated. Alcohol is prohibited, a low-fat or fat-free diet is recommended. If diabetes has developed, treatment and care practices are performed for it. B group vitamins, folic acid, B12, A, D, K vitamins and calcium can be given. 102 103  DISEASES OF THE GALLBLADDER AND ITS TRACTS 104 GallStones (Cholelithiasis)-01 Etiology: Age (40 and over), multiple birth-estrogen, contraceptive drugs, gender (2-3 times more in women), race, advanced obesity, cystic fibrosis, rapid weight loss, cholesterol density of bile, bile stasis, diabetes, cirrhosis, chronic hematolytic diseases. Symptoms: Bile colic, nausea, vomiting, abdominal pain and feeling of fullness in the stomach, jaundice, infection, pancreatitis. 105 106 107 108 GallStones (Cholelithiasis)-02 Complication: The most serious complication is gallbladder perforation. Because it causes peritonitis. Purpose of Treatment: Controlling pain; control nausea-vomiting; to maintain fluid- electrolyte balance; prevent infection. Cholesterol stones can be dissolved by laparoscopy, by oral administration of ursedoxycholic acid, and can be treated with shock waves and lithotripsy. 109 GallStones (Cholelithiasis)-03 Nursing Interventions Dolantin and Demerol are preferred as pain relievers. Pain is evaluated. Nasogastric decompression is applied to reduce nausea-vomiting and pain. The fluids lost by the patient are met by IV route. Large-spectrum antibiotics are given. Side effects of the applied treatment methods are monitored. The course of the disease, treatments, complications and applications are explained to the patient and their anxiety is relieved. 110  Acute Cholecystitis It is inflammation of the sac, which often develops due to a stone obstructing the ductus cysticus. Sedentary life, obesity increases the risk of acute cholecystitis. Symptoms: Sudden onset of pain, jaundice, nausea, local tenderness, fever, Murphy's sign (interruption of inspiration in deep inspiration while examining the right upper quadrant). Treatment and Care: In acute cholecystitis, the patient should be hospitalized. Appropriate antibiotics are given. The patient is followed 111 112  Chronic Cholecystitis It is similar to acute cholecystitis, but the pain and other signs are milder. The temperature is not high and the leukocyte count is lower. Its treatment is supportive. Low-fat diet, antacids, anticholinergics and sedatives are given. If the patient is overweight, it is recommended to lose weight. If necessary, cholecystectomy is performed. 113 114 Acute and Chronic Hepatitis Acute viral hepatitis can occur with 5 types of viruses. These: hepatitis A virus (HAV) hepatitis B virus (HBV) hepatitis C virus (HCV) hepatitis D virus (HDV) hepatitis E virus (HEV) hepatitis G virus (HGV) 115  Hepatitis A-01 It is a common infection all over the world. It is most common in schoolchildren and young adults. Transmission is usually by the fecal-oral route. It does not become chronic. The most important source of transmission is individuals with acute infection. Its most important feature is that it causes recurrent epidemics. In developing countries, it is common in places where health conditions are not good and where people live together. The incubation period is 15-50 (average 30) days. 116 117  Hepatitis A-02 Treatment and Care: There is no specific treatment other than rest. The most effective way to prevent infection is to prevent infected people from contaminating sources such as water, food, and hand washing. The patient's glasses and counters should be separated, and the toilet used by the patient should be disinfected at frequent intervals. The patient can continue his/her daily life provided that he/she does not get too tired, takes a normal diet, and antiemetics can be given when he has nausea. 118  Hepatitis A-03 Immunization: In active immunization, the inactive vaccine is administered to the deltoid muscle. The protection period is 8-10 years. The vaccine is administered to children, nursery staff, soldiers, gay people, travelers to endemic areas and those who have the habit of using IV drugs. Especially children living in 119  Hepatitis A-04 Transmission Way: Eating vegetables and fruits washed with contaminated water, dishes that are not cooked well, washing the tools and equipment used in the kitchen with dirty water, and the carrier or hands of the person preparing the food create a risk of contamination. 120  Hepatitis A-05 Those at Risk of Hepatitis A: Children in kindergartens, kindergartens, schools and their staff Travelers to areas with poor sanitation Healthcare workers, laboratory staff Military personal Prisoners and officials Blood transfusions and hemodialysis patients Those whose relatives have had hepatitis A 121  Hepatitis A-06 Prevention: Not drinking tap water that is not sure of its cleanliness, not using ice formed from this water, not brushing teeth with this water. Maintaining adequate sanitation, cleanliness and personal hygiene, washing hands thoroughly with soap and water before meals and after using the toilet Not eating unpeeled fruits, salads, uncooked vegetables without washing and avoiding raw seafood 122  Hepatitis A-07 Prevention: Not eating food and drinks prepared in the streets without paying attention to the cleaning rules If traveling to underdeveloped countries, only drinking bottled water, not consuming foods prepared with water or washed with water, such as vegetables, fruits and soups. In order to prevent the spread of the disease among family members, not sharing items such as bedding, towels, dining utensils, glasses and ensuring adequate cleaning 123  Hepatitis B-01 It is an infectious disease of the liver caused by HBV. The incubation period of HBV, which is found in all body fluids, is 28-180 (average 70-80 days). In 10% of adults, the infection becomes chronic, in newborns it is 100%. Parenteral, sexual, perinatal and horizontal transmission of HBV are the four main modes of transmission. 124 125  Hepatitis B-02 Risk Groups: Babies born to mothers with hepatitis B Patients or carriers of hepatitis B at home Having sexual relations with more than one person Users of blood and blood products Persons undergoing hemodialysis Intravenous drug addicts Health personnel People living in communal areas 126  Hepatitis B-03 Diagnosis: Serological indicators. HBsAg virus rises after exposure, and if it lasts longer than 6 months, the disease becomes chronic. 127  Hepatitis B-04 Symptoms: extreme weakness, feeling tired; loss of appetite, nausea-vomiting; yellowing of the skin and whites of the eyes; urine being the color of tea; abdominal pain, tenderness in the liver 128  Hepatitis B-05 Treatment and Care: There is no specific treatment other than rest. In case of excessive nausea and vomiting, in the presence of another disease, the patient should be hospitalized and monitored. Treatment of acute HBV infections in hospital is usually supportive. Treatment with antiviral drugs is sometimes tried in fulminant hepatitis and in long-term, severe cases. In hepatitis B, care is directed towards symptoms such as hepatitis A. Measures regarding blood and blood fluids are taken until HBsAg (-) is found in the patient's serum. 129  Hepatitis B-06 Prevention: HBV vaccine is administered to health personnel, blood bank workers, patients who are given frequent blood and blood products such as hemophilia-thalassemia, patients undergoing hemodialysis, those who have the habit of using IV drugs, babies born from HBsAg (+) mothers, prisoners, sex workers and It is recommended for gay people, first aid practitioners. 130  Hepatitis C-01 HCV transmission route is similar to HBV as parenteral, sexual, horizontal and vertical. Transfusion of infected blood and blood products is the most common mode of transmission in HCV infection. HCV infection is more common in hemodialysis patients, IV drug addicts, organ transplant recipients, and those using blood products. Healthcare personnel are also a risk group for HCV. However, the risk is much lower than HBV. The incubation period for acute HCV 131 132  Hepatitis C-02 Diagnosis: Anti-HCV ELISA antibody tests, supportive tests, PCR and HCV-RNA determination are mainly used in the diagnosis of HCV infection. Treatment and Care: Rest is important in treatment. The most important problem is the high rate of chronicity. There is no specific immunoglobulin and vaccine against HCV. 133  Hepatitis C-03 Protection: It depends on the resources and the measures to be taken. It is important to avoid unnecessary blood transfusions, to screen donor blood and blood products for HCV infection, to purify them from HCV, to screen organ donors, and to educate risk groups. 134  Hepatitis D-01 HDV does not function in the absence of HBV. The most important mode of transmission is parenteral. The incubation period of the infection is 15-80 days. Diagnosis: First HBV and then HDV increase in transaminases. Its prognosis is worse, and chronicity can be up to 70%. Treatment, Care, Prevention: Same as 135 136  Hepatitis E-01 Its epidemiological features are similar to HAV. It is transmitted by the fecal-oral route. However, it is less contagious. It is more common in the young and middle age group. The incubation period of the infection is 15-75 (mean 36) days. Diagnosis: The disease is detected by anti-HEV. Treatment and Care: There is no specific treatment. Prevention: Plasma immunoglobulin 137  Hepatitis G-01 Hepatitis G; It is a new form of hepatitis that is not A, B, and C. The incubation period after transfusion is 14-145 days. The risk factors are the same as for HCV. 138 Nursing Diagnoses in Hepatitis Activity intolerance Tiredness Inability to move physically due to bed rest Undernutrition of the organism due to nausea-vomiting Anxiety Deterioration of tissue integrity due to itching Lack of information Risk of getting an infection (for nurses) Risk of transmission of infection (for patients) 139  Aim of Care Ability of the patient to perform daily activities Ensuring an adequately balanced diet Reducing anxiety Non-disruption of tissue integrity Addressing the lack of information 140  Nursing Interventions Assisting in daily activities when needed Restricting unnecessary activities To prevent complications due to prolonged bed rest Providing adequate nutrition Providing information about the disease, the process, the consequences, and the importance of treatment and reducing anxiety by allowing the patient to ask questions. To prevent itching, to ensure that nails 141  Liver Cirrhosis-01 Hepatocellular necrosis is a progressive, irreversible disease in which fibrosis and regeneration coexist. Etiology: Alcohol, hepatitis B and C viruses, drugs and toxins, autoimmune chronic active hepatitis biliary cirrhosis, chronic liver congestion, genetic metabolic diseases and cryptogenic causes. Diagnosis: USG, CT, endoscopy, peritonoscopy, liver biopsy. 142 143 144  Liver Cirrhosis-02 Classification Alcoholic Cirrhosis (Laennec): Its development is related to the amount and duration of alcohol use, gender and genetic factors. Fatty liver is the most common change in alcoholic cirrhosis. Biliary Cirrhosis: It is a form of cirrhosis that develops with destruction and cholestasis in the intrahepatic bile ducts. Cardiac Cirrhosis: It develops due to continuous congestion of the liver. Wilson's Cirrhosis: It develops as a result of accumulation of copper in the liver. Post Necrotic Cirrhosis: Hepatitis B and C eventually develop due to liver changes. 145  Liver Cirrhosis-03 Treatment: There is no definitive treatment for cirrhosis. Treatment is symptomatic and directed towards complications. Complications: Portal hypertension, spleen enlargement, ascites accumulation, hepatic encephalopathy, hepatopulmonary syndrome, hepatorenal syndrome, spontaneous bacterial peritonitis, hemorrhage, hepatocellular carcinoma, liver failure. 146  Liver Cirrhosis-04 Nursing Diagnoses 'Fatigue' due to muscle wasting, blood loss and potential anemia 'Dietary change' due to anorexia, flu-like picture 'Liquid volume excess' due to aldosterone metabolism deficiency, hypoalbuminemia and acid 'Ineffective breathing' due to acid buildup and immobility 'Risk of deterioration of skin integrity' due to malnutrition, edema, jaundice ‘Itching' due to jaundice 'Risk of infection' due to suppression of the immune system 'Ineffective individual coping with serious health problem' 'Risk of injury' due to decreased metabolic functions of the liver Jaundice, acidity, 'deterioration in self-esteem', 147  Liver Cirrhosis-05 Nursing Interventions To apply bed rest in the acute phase and to prevent the side effects of limitation of movement. Encourage increasing activity after the acute phase, planning activities with frequent rest. Providing the patient with a balanced diet, restricting protein and sodium as necessary, ensuring that he receives adequate calories and vitamins. Ensuring that he receives a soft diet. 148  Liver Cirrhosis-06 Nursing Interventions To give antiemetic for nausea, to apply oral care. To ensure that he takes meals in small quantities as 6 meals. To ensure that the patient eats the meals in a clean, cool and comfortable environment. To monitor the weight and measure the abdominal circumference while wearing the same clothes at the same time every day. 149  Liver Cirrhosis-07 Nursing Interventions To monitor the amount of fluid intake and output daily and to make fluid restriction. Administer diuretics and other medications on demand. Giving diuretics to resolve edema. To explain to the patient the reasons for sodium, protein restriction, etc. To evaluate the skin regularly, to change the position of the inpatient constantly, to keep the skin dry and clean, to ensure that the nails 150are  Liver Cirrhosis-08 Nursing Interventions Giving prescribed antihistamines. Do not use very hot water in the bathroom. Watching for signs of infection. To apply sterile technique in all invasive procedures. To perform practices such as coughing, deep breathing and changing positions to ensure pulmonary hygiene. 151  Liver Cirrhosis-09 Nursing Interventions Monitoring for urinary, intestinal, skin and mucous membrane bleeding. Monitor the patient's vital signs every 4 hours. Applying pressure to the injection sites for 5 minutes. Giving vitamin K on demand. Using a soft toothbrush. 152  Liver Cirrhosis-10 Nursing Interventions To take measures to prevent the patient from falling during ambulation. To ensure environmental safety. To allow the patient to express his feelings about self-esteem, body image changes and deterioration in role performance, sexual problems, to encourage the patient and to cooperate with his family. 153 THANK YOU! 154