Assessment of Clients with GI Disorders PDF

Assessment of Clients with GI Disorders Assessment of Clients with GI Disorders History Physical Examination Demographic data, religion, personal and Assessing Oral Cavity family history:...

Assessment of Clients with GI Disorders Assessment of Clients with GI Disorders History Physical Examination Demographic data, religion, personal and Assessing Oral Cavity family history: Inspection  o Lips- for abnormal color, lesions, nodules, General Health status symmetry  Previous G.I. disorders and surgery o Oral mucosa- redness, pallor, swelling, ulcers  Change in bowel habits, G.I. bleeding, or leukoplakia. jaundice, weight loss. o Gums- redness, pallor, ulcers, bleeding  Any medications taken routinely. o Teeth- dental caries, dentures,  Long term use of laxatives missing/broken teeth  Family history of G.I. disordersAssessment of o Tongue- color, ulcers, abnormal coating, Clients with GI Disorders swelling or deviation to one Diet History side, movement  Usual foods and fluids that are typically o Pharynx- tonsil abnormalities, lesions, ulcers, consumed. uvular deviation, unusual  Quality and quantity of foods ingested. mouth odor  Relationship of food intake and G.I. symptoms Assessment of Clients with GI Disorders  Usual and current appetite  Symptoms such as nausea and vomiting, Physical Examination difficulty of swallowing.Assessment of Clients Assessing the Abdomen with GI Disorders Position- Supine with knees flexed (dorsal Chief Complaint (e.g. abdominal pain) recumbent position) Sequence: Inspection, Auscultation, The nurse should ask the ff questions: Percussion, Palpation (“IAPePa”) ◦ Critical to Remember: Onset Auscultation is performed in the abdomen o before percussion and palpation. This is because Duration percussion and palpation can increase intestinal o activity and therefore alter bowel sounds. Quality and Characteristics No abdominal palpation is done in patient with o tumor of the liver or kidney. Severity o To prevent rupture of the tumor and massive Location internal hemorrhage.Assessment of Clients with o GI Disorders Precipitating Factors o Inspection o - Abdomen- condition of the skin, contour Relieving Factors Skin should be smooth, intact. Contour of the o abdomen is flat, concave, rounded or distended depending on the client’s body type. Associated symptomsAssessment of Clients - Inspect umbilicus- shape, position, color with GI Disorders (concave, located at midline, same color as the abdominal skin) Medical History - Note abdominal movements, pulsations, Major illnesses and hospitalizations peristaltic movement. Normally, peristaltic Use of medications movements are not visible.Assessment of Allergies to foods and other substances Clients with GI Disorders Family History o Auscultation History of cancer, ulcers, colitis, hepatitis, Bowel sounds (5 to 35/minute) rapid, high- obesity pitched, loud bowel sounds are hyperactive (e.g. Psychosocial History and Lifestyle in gastroenteritis). Occupation- meal times and travel Hypoactive bowel sounds occur at a rate of one Social every minute or longer (paralytic ileus) or after o Stress- provoking situations bowel surgery. o Alcohol and nicotine Note: empty the bladder before auscultation of NPO for 10-12 hours the abdomen. Blood/urine levels are measured o Percussion Done for diagnosis of malabsorption - To determine the size and location of abdominal organs and to detect fluid, air and Diagnostic Tests masses.Assessment of Clients with GI Disorders o- Percussion sounds over abdomen: Laboratory Tests Tympanic- high-pitched, loud, musical over Exfoliative Cytology air Dull- thud-like sound over fluid or solid Done to detect malignant cells organs Written consent is obtained Liquid diet is given Note: Avoid abdominal percussion in clients Upper GI: Nasogastric tube (NGT) insertion is with suspected abdominal aneurysms and in done those clients with abdominal organ Lower GI: laxative the night before and transplants. enema in the morning Cells are obtained from saline lavage- via NGT Assessment of Clients with GI Disorders for UGI/ via proctoscope for LGIDiagnostic Tests Laboratory Tests o Palpation Fecal Analysis Stool for Occult Blood (Guaiac - Palpate abdomen by lightly depressing (1-2 cm) Stool Exam) the abdomen in o Done to detect G.I. Bleeding quadrant to quadrant manner. o Provide high fiber diet for 48-72 hours - Assess for masses, rebound tenderness, o No red meats, poultry, fish, turnips, abdominal rigidity. horseradish, cauliflower, broccoli and melon. - Deep abdominal palpation should be O Vitamin C causes false negative reading. performed cautiously only by a skilled nurse.Assessment of Clients with GI Diagnostic Tests Disorders o Occult blood test is done by placing hydrogen Anthropometric Measures peroxide to the stool specimen. If blue ring is 1. Height and Weight formed, this indicates bleeding. 2. Body Mass Index (BMI) o Withold for 48 hours: Iron, Steroids, BMI= Weight in kg./height(m2) Indomethacin, Colchicine 3. Circumferential Measurements - Iron causes blackish/greenish discoloration of stool. This may be mistaken as bleeding. This Midarm muscle circumference (MAMC) causes false positive result. - Steroids, Indomethacin, Colchicine may cause Waist-to-hip proportions (greater than 0.8 in GI bleeding. These medications may cause false women and 1.0 for men indicate fat distribution positive result. that is associated with negative health o 3 stool specimen will be collected (3 outcomes. Assessment of Clients with GI successful days) Disorders Diagnostic Tests Body Mass Index (BMI) Stool for Ova and Parasites 18.5-24.9 Normal o Send fresh, warm stool specimen, especially if 25.0-29.9 Overweight the purpose of the test is to detect amoebiasis. 30 and above Obese Stool Culture o Use sterile test tube and cotton- tipped Diagnostic Tests applicator to collect specimen. This ensures that Laboratory Tests the specimen is not contaminated.Diagnostic CEA (Carcinoembryonic Antigen) Tests Stool for Lipids (+) in colorectal Ca o Done to assess steatorrhea o Include fats in the diet. To assess ability of the Avoid Heparin for 2 days GI to metabolize fats. o Avoid alcohol for 3 days. Alcohol mobilizes Specimen is obtained by venipuncture fats. This will cause false positive result. D- Xylose Absorption Test o 72- hour stool is collected. Store the specimen Initial blood/urine specimen are collected on ice. o Avoid mineral oil, neomycin SO4 and other Care after the procedure – same as oily medications.Diagnostic Tests UGISDiagnostic Tests Gastric Analysis Computed Tomography Measures secretion of HCL and pepsin. Uses beam of radiation to assess cross NPO for 12 hours. sections of the body NGT is inserted, connected to suction. Clear liquid diet in the morning Gastric contents are collected every 15 If the procedure is done with contrast minutes to 1 hour. medium Increased HCl: Zollinger-Ellison Syndrome o NPO for 2-4 hours o Assess history of allergy to seafoods and Doudenal Ulcer iodine Inform the client that the procedure is Decreased HCl: Gastric Ca painless Pernicious AnemiaDiagnostic Tests Assess for claustrophobia Bernstein Test (Acid Perfusion Test) Advise the client to remain still during the To assess if chest pain is related to gastro- entire procedureDiagnostic Tests esophageal reflux. Endoscopy NPO 6-8 hours Upper GI Endoscopy NGT insertion Direct visualization of esophagus, stomach, Alternate instillation of NSS and 0.1 % HCL and duodenum If no pain is experienced (-) for gastro- Obtain written consent esophageal reflux; if pain is experienced (+) NPO for 6-8 hours gastro-esophageal reflux. Antacid is Administer anticholinergic (e.g., At SO4) as administered after the procedure to relieve ordered. To reduce discomfort. mucus secretions and prevent aspiration. Sedatives, narcotics, tranquilizers. To relax Diagnostic Tests the client. E.g. Diazepam, Meperidine HCl Diagnostic Tests o Radiographic Tests Remove dentures, bridges. To prevent airway Scout Film/ Flat Plate of the Abdomen obstruction. Plain X-ray of the abdomen Local spray anesthetic (Lidocaine) on Avoid belts or jewelries. Metals are posterior pharynx is administered to depress radiopaque the gag reflex. Instruct the client not to UGIS (Upper G.I. Series/Barium Swallow) swallow saliva. For maximum effect of the To visualize the esophagus, stomach, anesthetic. Lidocaine is unpalatable. duodenum, and jejunum After the procedure NPO for 6-8 hours o Place the client in side-lying position. To Barium Sulfate (BaSO4) by mouth is prevent aspiration. administered. Barium Sulfate is a white, chalky o NPO until gag reflex returns (2-4 hrs). substance.Diagnostic Tests o NSS gargle; throat lozenges. To soothe the X-rays are taken on standing, lying positions. throat.Diagnostic Tests After the procedure: o Monitor VS (vital signs) o Laxative is administered. Barium Sulfate o Assess: bleeding, crepitus (neck), fever, neck/ causes constipation. throat pain, o Increase fluid intake. To prevent constipation. dyspnea, dysphagia, back/shoulder pain o Inform client that the stools are white for 24- oAdvise to avoid driving for 12 hours if sedative 72 hours. This is due was used. to the evacuation of Barium Sulfate. o Observe for Barium impaction manifestations: Lower GI Endoscopy distended abdomen, constipationDiagnostic Proctosigmoidoscopy (sigmoid, rectum) Tests o Clear liquid diet 24 hours before the LGIS (Lower G.I. Series/ Barium Enema) procedure. To visualize the colon o Administer cathartic/ laxative as ordered. Low residue/clear liquid diet for 2 days o Cleansing enema.Diagnostic Tests Laxative for cleansing the bowel o Intestinal evacuant like Golytely may be Suppository/ cleansing enema in A.M. administered in place of BaSO4 is administered per rectum enema. Instruct the client to take 240 cc every 10 minutes up to 2 hours. It is expected that the client will have (undernutrition and overnutrition) over an watery stools (diarrhea). extended period. It involves both starvation and o Place the client in knee-chest/ lateral position obesity. during the procedure. 2 types of starvation are as follows: o Assess the signs of vasovagal stimulation. The 1. Primary Malnutrition- occurs when adequate GI tract is supplied by the Vagus nerves. nutrition is not delivered to upper GI tract over an extended period. Diagnostic Tests 2. Secondary Malnutrition- occurs when the o After the procedure upper GI tract fails to absorb, metabolize, or use Supine position for few minutes. To prevent nutrients.I. Management of Patients with postural hypotension. Malnutrition Assess for signs of perforation- Bleeding, Pain, and Fever Different types of malnutrition associated Hot Sitz bath to relieve discomfort in the with protein and calorie deficits are as follows: anorectal area. Colonoscopy o Preparation of the client is same as in proctosigmoidoscopy. o Sedation is done to relax the client. o Position during the procedure: left side, knees flexed.Diagnostic Tests o After the procedure Monitor VS (note for vasovagal response, e.g. bradycardia, hypotension) Assess for signs and symptoms of perforation. Ultrasonography of the abdomen o NPO for 8-12 hours. oLaxative as ordered (to reduce the bowel gas)Diagnostic Tests MRI (Magnetic Resonance Imaging) o Produces cross-sectional images of organs by using magnetic fields. 1. Kwashiorkor o NPO for 6-8 hours. Inadequate protein intake with adequate o Instruct to remain still during the procedure. calorie intake. Body weight at or above ideal o Inform that procedure may last for 60-90 weight. Edema sometimes present. Visceral minutes. proteins (albumin, prealbumin, transferrin) o Remove jewelries/metals. below normal. Management of Patients with Contraindications Malnutrition KwashiorkorI. Management of Pacemakers Patients with Malnutrition Aneurysm clips Orthopedic screws 2. Marasmus Related Nursing Procedures for Inadequate calorie and protein intake. Gastrointestinal System Cachectic appearance Body weight and 1. Gastric and Intestinal Decompression anthropometric measurements (height, weight, 2. Esophageal and Balloon Tamponade frame size, body mass index, mid-arm muscle 3. Enteral Feeding circumference (MAMC), waist- to- hip This may be nasogastric tube feeding or proportions) below normal Visceral proteins gastrostomy feeding with normal range. 4. Total Parenteral Nutrition (TPN) 5. Administering EnemasI. I. Management of Patients with Malnutrition 2. Marasmus Management of Patients with Malnutrition Malnutrition occurs when nutrient availability is inadequate or excessive  is characterized by an excess accumulation of fats and reflects an overall imbalance between energy intake and expenditure. increases risk for cardiovascular disease, elevated blood pressure, blood lipids, and blood glucose levels. increases risk for colorectal cancer, breast, and prostate cancer Eating Disorders Outcome Management of Obesity: Diet Behavior modification Exercise Inadequate calorie and protein intake. Medication (occasionally) Cachectic appearance Body weight and If these therapies fail, surgical treatment may be considered (ex. jejunum bypass, gastric anthropometric measurements (height, weight, frame size, body mass index, mid-arm muscle stapling) circumference (MAMC), waist- to- hip Eating Disorders proportions) below normal Visceral proteins Metabolic syndrome with normal range.I. Management of Patients Increased BP with Malnutrition MarasmusI. Management of Insulin resistance Patients with Malnutrition Excess body fats/obesity around waist (apple shape)/ Central 3. Mixed obesity Inadequate calorie and protein intake with Elevated trigylcerides increased nutritional requirements. Cachectic Low HDL levels appearance. Body weight and anthropometric High blood pressure Eating Disorders measurements below normal. Visceral proteins below normal. 2. Anorexia Nervosa and Bulimia Nervosa I. Management of Patients with Malnutrition 3. Mixed Anorexia nervosa Inadequate calorie and protein intake with intentionally imposes severe dietary restrictions, increased nutritional requirements. Cachectic resulting in weight loss, endocrine dysfunction, appearance Body weight and anthropometric and fluid and electrolyte imbalance. body’s image is grossly distorted, and attitude measurements below normal. Visceral proteins below normalI. Management of Patients with toward Malnutrition eating is impaired. Eating Disorders Pellagra Vitamin B3 (Niacin deficiency) Bulimia Nervosa Clinical Manifestations similar distortions in attitudes toward weight Scaly rashes (dermatitis) Edema and eating; however, this is characterized by frequent binge eating and purging (vomiting). Mucosal inflammation Insomnia Mental changes (e.g. dementia) The client may abuse laxatives and diuretics as Sensitivity to sunlight well. Diarrhea Eating Disorders AlopeciaI. Management of Patients with Malnutrition 4D’s of Pellagra Physical Manifestations of Anorexia Nervosa Dermatitis  Dizziness Diarrhea Dry, brittle hair Dilated cardiomyopathy Lanugo-tyoe hair Dementia Low BP, pulse, ECG voltage Treatment: Niacin/Nicotinamide Eating Orthostasis Disorders Cachexia  Biochemical changes: WBC- Up, Glucose- 1. Obesity Down, Cholesterol- Up, Carotene- Up Stool retention Eating Disorders  Gastritis Physical Manifestations of Anorexia Nervosa An inflammation of the gastric mucosa,  Acrocyanosis classified as either acute or chronic. Amenorrhea 1. Acute Gastritis Muscle wasting Diminishing DTRs Risk Factors: Osteoporosis - Foods with rough texture or those eaten at Dry skin extremely high temperature Edema - Ingestion of corrosive agents such as lye, or Growth Retardation drain cleaner. Hypothermia Eating Disorders - Prolonged emotional tension. Gastritis Clinical Manifestations Physical Manifestations of Bulimia Nervosa 1. Epigastric discomfort  Salivary Gland enlargement 2. Abdominal tenderness  Enamel erosion 3. Cramping  Esophagitis 4. Belching  Arrythmias 5. Reflux  Normal weight or underweight 6. Severe nausea and vomiting  Callus in the fingers 7. Hematemesis  Biochemical changes: (K - Down, CD2- Down, 8. Diarrhea (within 5 hours of ingestion of Amylase- Up) Eating Disorders contaminated food) Gastritis Interprofessional Collaborative Management Physical Manifestations of Bulimia Nervosa for Patients with Acute  Diarrhea Gastritis  Edema 1. Remove the cause and treat the  Russel sign (Bruised knuckles due to self- manifestations induced - Antiemetics vomiting) Eating Disorders - Antacids or histamine (H2 receptor antagonists) Nursing Diagnosis for the Client with Eating - NPO until nausea and vomiting subside Disorders - Once the patient tolerates food, the diet Altered nutrition: Less than body includes decaffeinated tea, requirements related to gelatin, toast, and simple bland foods. inadequate food intake (anorexia nervosa) - Avoid spicy foods, caffeine, and large heavy Altered nutrition: More than body meals. Gastritis requirement related to 2. Chronic Gastritis increased food intake (bulimia nervosa and 3 different forms of chronic gastritis are as obesity) follows: Body image disturbance related to a. Superficial gastritis misconception of body It causes a reddened, edematous mucosa with size or negative feelings (all disorders) small erosions and Risk for injury: Dysrhythmias related to hemorrhages. hypokalemia (both b. Atrophic gastritis anorexia and bulimia) Is characterized by a decreased number of Gastritis parietal and chief cells. An inflammation of the gastric mucosa, It occurs in all layer of the stomach, develops classified as either acute or chronic. frequently in association 1. Acute Gastritis with gastric ulcer and gastric cancer and is invariably present in Risk Factors: pernicious anemia. - Ingestion of corrosive, erosive, or infectious substance (ASA, NSAIDs, digitalis, 2. Chronic Gastritis chemotherapeutic drugs, steroids, acute, c. Hypertrophic gastritis alcoholism, food poisoning) It produces a dull and modular mucosa with - excessive amounts of tea, coffee, mustard, irregular, thickened, or modular rugae; paprika, cloves and hemorrhage occur frequently. pepper. Risk factors - Age-chronic gastritis - Peptic ulcer disease (PUD) 5. Drugs - Aspirin, NSAIDs, steroids - Helicobacter pylori infection 6. Gastritis - Gastric surgery 7. Zollinger-Ellison Syndrome - (Other risk factors are similar to those for 8. Irregular, hurried meals acute gastritis) Gastritis Chemical Manifestations Predisposing factors for peptic disease are as 1. Anorexia follows: 2. Feeling of fullness 9. Fatty, spicy, highly acidic foods 3. Dyspepsia 10. Type A Personality (Stress Personality) 4. Belching 11. Type O blood 5. Vague epigastric pain 12. Genetics Gastric Ulcers 6. Nausea and vomiting Also called “poor man’s” or “laborer’s” ulcer 7. Intolerance of spicy or fatty foods Gastritis because the stomach is usually empty Interprofessional collaborative management 20% incidence for the patients with chronic gastritis: Commonly affects those who are 50 years old 1. Bland diet, small frequent meals, antacids, and above. Older people usually lose interest in anticholinergics, sedative, and avoidance of food. foods that cause manifestations. Affects those who are malnourished. 2. If H. pylori infection is present: Clarithromycin Pathophysiology: There is increased back- (Baxin), Metronidazole (Flagyl), Omeprazole diffusion of HCl into (Prilosec) as prescribed. gastric mucosa. There is normal gastric emptying rate. Note: Medications used to treat chronic There is normal HCl secretion. gastritis are the same Pain radiates to left side of the abdomen. as those given for treatment of PUD. (Stomach is located in the left side of the abdomen) 3. Corticosteroids may be prescribed for parietal Pain is experienced 1/2 to 2 hours after eating cell regenaration. or even during meals. 4. Vitamin B12 IM injections, monthly if the When food comes in contact with exposed client has pernicious anemia. nerve endings in areas of ulcers, pain occurs. 5. Reduce pain Pain is not relieved by food intake. Food may - Avoid foods and beverages that cause pain even worsen the pain when it comes in contact - Avoid alcohol consumption with ulcers. - Avoid smoking Characteristics manifestations are nausea and - Aluminum hydroxide with Magnesium vomiting and hematemesis (vomiting with blood) Trisilicate (Gaviscon) which produces a soothing Complications may be hemorrhage, foam, is the best antacid for gastritis. perforation, peritonitis. Duodenal Ulcers - H2 receptor antagonists, proton pump Also called “executive” ulcer because it is inhibitors (PPIs), antisecretory agents also primarily stressrelated. provide pain relief. 80% incidence Peptic Ulcer Disease (PUD) An impairment of Commonly affects those who are 25 to 50 the mucosa and deeper structures of the years of age. The esophagus, stomach, duodenum. The jejunum years of “struggles” in life (stressful) may be affected if it is surgically anastomosed Usually well-nourished to the stomach. Pathophysiology: There is increased HCl secretion. The cause of peptic ulcer is Helicobacter pylori Pain radiates to the right side of the abdomen infection. Helicobacter pylori infection is usually (Duodenum is due to eating raw or improperly cooked meat. located in the right side of the abdomen). Peptic Ulcer Disease (PUD) Duodenal Ulcers ◦Pain is experienced 3 to 4 hours after eating. Predisposing factors for peptic disease are as This is the time when acidic chyme from the follows: stomach empties into the duodenum. The 1. Stress exposed nerve endings in the duodenum are 2. Cigarette smoking irritated by the acidic chyme. 3. Alcohol 4. Caffeine ◦Pain is relieved by food intake. Food in the  stomach delays emptying of gastric acid into the Pepcid ( Famotidine) duodenum. Side effects: diarrhea, abdominal cramps, ◦Pain is commonly experienced between confusion, dizziness, 12:00MN and weakness 3:00AM. This is the time when there is Cimetidine may cause mental confusion, increased gastric acid secretion. (REM stage of agitation, psychosis, sleep). depression, anxiety and disorientation, anti- androgenic effects Duodenal Ulcers (gynecomastia, decreased libido, impotence) ◦ Characteristic manifestation is melena (black, Peptic Ulcer Disease tarry stools). Melena is black and tarry because c. Cytoprotective drug. To coat the ulcers. the blood is acted upon by gastric acid. Enhances ◦ Complications may be obstruction, prostaglandin synthesis. hemorrhage, perforation, peritonitis. Example: Carafate (Sucralfate) Administer the medication on empty stomach Both types of PUD are characterized by dull, (30 to 60 aching, gnawing epigastric pain. minutes before meals) Peptic Ulcer Disease Hemorrhage is the most Sucralfate may cause constipation life- threatening complication of PUD. Blood loss Administer Sucralfate at least 60 minutes of 20% (1,000mls.) is fatal. This leads to apart from the antacid. hypovolemic shock. Interprofessional d. Prostaglandin analogue. Collaborative management for patients with Replaces gastric prostaglandin. It suppresses peptic ulcer disease are as follows: secretion of gastric acid. 1. Medications Ex. Cytotec (Misoprostol) a. Antacids. To neutralize HCl. Best administered  Misoprostol is administered with meals. 1 to 2  It causes diarrhea and abdominal pain hours after eating. This is the time of peak of It is abortifacient, therefore it is HCL secretion. Peptic Ulcer Disease contraindicated in pregnancy. Ex: Amphogel, Alu-Cap, Dialume (Aluminum  Proton pump inhibitors (PPI’s). Hydroxide gel) Basaljel (Aluminum Carbonate) Suppress gastric acid secretion. Maalox (Aluminum-Magnesium Hydroxide) Common side effects: Tums, Rolaids, Alka-2 (Calcium Carbonate) Headache Milk of Magnesia, MOM (Magnesium Hydroxide) diarrhea Gaviscon (Aluminum Magnesium Trisilicate) abdominal pain Riopan (Magaldrate) Maalox plis Gelusil nausea Peptic Ulcer Disease (Aluminum Magnesium Hydroxide with e. Anticholinergics Simethicone) Reduce gastric motility (antispasmodic) and Magnesium- based antacids cause diarrhea. hydrochloric acid secretion Aluminum-based antacids cause constipation  Atropine Sulfate and hypophosphatemia (reduce phosphate  Bentyl (Dicyclomine) absorption).  Robinul (Glycopyrrolate) Simethicon relieves flatulence.  Levsin, Nulev (Hyoscyamine) Peptic Ulcer Histamine H2 Receptor Antagonists Disease (Histamine blockers). To reduce HCl secretion. f. Helicobacter Pylori Drug treatment Best taken in the morning and at bedtime. Food The antimicrobials effective for H. pylori may delay the rate of absorption of the infection are as follows: medication.  Amoxil (Amoxicillin) ◦ Histamine H2 Receptor Antagonists to  Biaxin (Clarithromycin) suppress secretion of gastric  Flagyl (Metronidazole) acid.  Achromycin (Tetracyclin)  Advise client to avoid alcohol when on Flagyl Tagamet (Cimetidine) Therapy. To prevent  disulfiram-like manifestations. Peptic Ulcer Zantac ( Ranitidine) Disease  If alcohol is used when on Flagyl therapy, the Axid (Nizatidine) patient experiences the ff S/Sx: Liberal balnd diet is recommended during headache dyspnea exacerbation. Avoid hot, spicy, and highly hypotension respiratory and circulatory seasoned food. collapse vomiting convulsions Peptic Ulcer Disease nausea 3. Nursing Interventions for PUD flushing Advise patient to eat slowly and to chew tachycardia food properly. Small, frequent feedings during palpitations exacerbation. chest pain Peptic Ulcer Disease Tetracycline The patient should AVOID the following: teratogenic it is contraindicated in pregnancy. Fatty foods, coffee, tea, chocolate, cola drinks, Advise the client to avoid alcohol to prevent spices, red/black pepper, alcohol (these are disulfiramlike manifestations (headache, irritants and stimulants) Bedtime snacks (to hypotension, nausea and vomiting, flushing, prevent nightime reflux) Binge eating (to tachycardia, palpitations, chest pain, prevent gastric stimulation) Large quantities of dyspnea, respiratory and circulatory collapse, milk (milk is alkaline, thus it stimulates the convulsions) stomach to increase HCl secretion to neutralize Peptic Ulcer Disease it, causing rebound acidity). Peptic Ulcer 2. Surgical Interventions for PUD Disease a. Vagotomy 3. Nursing Interventions for PUD Resection of the vagus nerves. It results to The patient may take 400mls. of milk (2 glasses) decreased gastric motility and decreased HCl per day. Encourage the client to quit smoking secretion. Enhance coping through stress therapy. b. Pyloroplasty Develop recreation and hobbies Have regular Surgical dilatation of the pyloric sphincter. This pattern of exercise Stress reduction at home improves gastric emptying. Peptic Ulcer and at work. Disease c. Antrectomies c. Interprofessional collaborative management Surgical resection of 50% of the distal part of for the Patients Undergoing Gastric Surgery the stomach followed Preop care by anastomosis with the duodenum or jejunum. Provide psychosocial support Teach the client DBCT (deep breathing, Billroth I (Gastroduodenostomy) coughing and turning) exercises. Gastric surgery Anastomosis of the gastric stump with the involves the abdominal incision (near duodenum. This is indicated in gastric ulcer. diaphragm). Therefore, the client is at risk to develop respiratory complications (atelectasis, Billroth II (Gastojejunostomy) hypostatic pneumonia) during the postop Anastomosis of the gastric stump with the period. jejunum. The duodenum is bypassed (not removed) to permit the flow of bile. This is Peptic Ulcer Disease indicated in doudenal ulcer. Peptic Ulcer c. Interprofessional collaborative management Disease for the Patients Undergoing Gastric Surgery Provide nutritional support (TPN) as ordered. d. Subtotal Gastrectomy To enhance the client’s ability to withstand the Removal of 75% of the distal stomach with stress of surgery. Billroth I or II repair. Inform client and his family on post op 3. Nursing Interventions for PUD measures, e.g. NGT, oxygen therapy, blood a. Relieve pain by administering antacid as transfusion, TPN to prevent unnecessary anxiety. prescribed. Postop care b. Encourage patient to promote a healthy Priority is to promote patent airway and lifestyle. ventilation. To prevent atelectasis and hypostatic pneumonia (pneumonia due to The patient may eat anything that he can immobilization) tolerate when he is asymptomatic. Peptic Ulcer Disease c. Interprofessional collaborative management for the Patients Undergoing Gastric Surgery -Place client in semi-fowler’s position - Reinforce DBCT exercises and incentive spirometry - Administer analgesic 15 to 30 minutes before activities. (Pain management is a patient’s right). - Splint incision when patient coughs. - Encourage early ambulation. Peptic Ulcer Disease c. Interprofessional collaborative management for the Patients Undergoing Gastric Surgery Promote adequate nutrition -NPO (nothing by mouth) until peristalsis returns. Presence of bowel sounds (5 to 40 per minute) and passing out of flatus indicate return of persitalsis. -Provide progressive diet-clear liquid, full liquid, soft diet, full diet. -Provide small, frequent feedings. - Monitor for early satiety and regurgitation. Advise client to eat less food at a slower pace. Peptic Ulcer Disease c. Interprofessional collaborative management for the Patients Undergoing Gastric Surgery - Monitor weight regularly. Weight is the best indicator of nutritional status. Prevent potential complications -Bleeding. Highest risk during the first 24 hours; then on the 4th to 7th day post op due to nonhealing. a. Monitor nasogastric tube drainage. It is normally reddish for the first 12 hours, then it becomes dark red. b. Avoid unnecessary irrigation or repositioning of the NGT. Leakage from anastomosis may occur. c. Interprofessional collaborative management for the Patients Undergoing Gastric Surgery a. Monitor for signs of leakage e.g. dyspnea, pain and fever when orla fluids are initiated. b. Monitor for signs of peritonitis, e.g. severe abdominal pain, abdominal rigidity, fever