Promoting Health in Patients with GI Disorders PDF

12/8/24 1 Promoting Health in Patients with GI disorders KAYLA GALLAGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY 2 Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing manageme...

12/8/24 1 Promoting Health in Patients with GI disorders KAYLA GALLAGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY 2 Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing management of selected disorders of the gastrointestinal system Develop a teaching plan for a patient with gastrointestinal disorders. Discuss potential diagnostic procedures for patients experiencing gastrointestinal disorders 3 A&P Review Oral cavity Pharynx Esophagus Stomach Small intestines Large intestines Rectum Pancreas Liver Gallbladder 4 A&P review 5 A&P review 6 A&P review 7 Digestion review 8 Intestinal conditions Irritable bowel syndrome (IBS) Irritable bowel disease (IBD) oCrohn's disease oUlcerative colitis 9 1 7 8 oCrohn's disease oUlcerative colitis Bowel obstruction Diverticulitis 9 Irritable bowel syndrome (IBS) Presence of abdominal pain/discomfort with altered bowel habits without any other causative disease Risks oFemales > males oAges 15-49 oFamily history oEmotional stress oFood sensitivities Manifestations oCramping, abdominal pain, bloating, distention, gas, diarrhea and/or constipation, mucous or bloody stools Treatment oLifestyle and dietary modifications oEnsure adequate hydration oDiarrhea: probiotics, loperamide oConstipation: fiber supplements, laxatives 10 Low FODMAP diet Elimination phase oAvoid all high-FODMAP foods Reintroduction phase oAfter 2-4 weeks oSystematically add foods back in Maintenance phase oKeep what works for you and leave what doesn't 11 Crohn's disease Type of inflammatory bowel disease Causes inflammation to the deeper layers of structures lining the gastrointestinal organs between mouth and anus Patches of inflammation followed by patches of healthy tissue Relapsing and remitting course 12 11 Patches of inflammation followed by patches of healthy tissue Relapsing and remitting course Manifestations: diarrhea, rectal bleeding, abdominal pain (RLQ), flatulence, bloating, decreased appetite, fatigue Progression of illness: abscesses, fistulas around anus Association with smoke exposure/active smoking and antibiotic us 12 Crohn's disease Complication oAnemia oStricture formation oFistula oAbscesses oColorectal cancer oOsteoporosis Treatment oMild to moderate disease: PO mesalamine, immunomodulators, methotrexate, steroids oModerate to severe: immunomodulators, biologics oSurgical: colectomy 13 Ulcerative colitis Type of inflammatory bowel disease Affects colon and rectum Continuous pattern of small sores or ulcers of the superficial mucosa and submucosa that lines colon and rectum Manifestations: bloody diarrhea, fecal urgency, fatigue, increased bowel movements, mucous in stool, nocturnal bowel movements, abdominal pain, malaise, weight loss Association with past bacterial or viral infection and developing UC 14 Ulcerative colitis Complications oColorectal cancer oAbscess oFistulas oIncontinence oToxic megacolon 14 oIncontinence oToxic megacolon Treatment oInitially: suppository, enema, PO (mesalamine) oCorticosteroids (supp or PO) oProbiotics to help maintain remission oIf doesn’t work... biologics oSurgical §Colectomy (curative) 15 Bowel obstruction Blockage in the small or large intestines that keeps food or liquids from passing through Manifestations: sharp or cramping abdominal pain, bloating, distention of the abdomen, diarrhea, inability to pass gas or stool, loss of appetite, N&V Association with past abdominal surgery, IBD, cancer Partial treatment – laxatives and dietary changes Complete treatment – IVF, NG for decompression, meds for nausea and pain, surgery 16 Bowel obstruction 17 Diverticulosis Diverticula most frequently present in sigmoid colon Areas of weakness in the intestinal tract If it becomes inflamed or infected = diverticulitis Diverticulosis develops with age Associated with: obesity, smoking, lack of exercise, low fiber, high fat diet, and medications oMedications: steroids, opioids, NSAIDs 18 Diverticulitis Infection or inflammation of diverticula Manifestations: abdominal pain, N&V, fevers, abdominal pain, constipation or diarrhea Complications: abscess, blockage, fistula, peritonitis, perforation, sepsis Treatment 19 18 sepsis Treatment oOutpatient or inpatient oBowel rest, increased fluid intake (PO or IV if inpatient), antibiotic, pain management 19 Diagnostic test: colonoscopy Flexible fiberoptic tube inserted into the colon Assesses entire colon Ability to visualize, take biopsies, remove polyps, etc Bowel prep prior (varies by situation, patient, and provider) Typically, sedation used Cardiac and respiratory monitoring throughout 20 Diagnostic test: sigmoidoscopy Visualizes rectum and sigmoid Useful if cannot tolerate prep, sedation, severe inflammation of colon, or only need to visualize the sigmoid Typically, no sedation 21 Capsule endoscopy Client swallows pill that is a camera Camera will visualize the GI tract Takes 2 pictures every second for 8 hours Bowel prep before and NPO before and 2 hours after Data retriever stays with the patient 22 What labs do you think will be ordered for each type of intestinal disorder? 23 What will be included in your assessment? 24 Let's review: fiber supplement 25 Let's review: laxatives 26 Let's review: corticosteroids (GI specific) 27 References ATI Engage Medical-surgical: Alterations in digestion and bowel elimination ATI Engage Medical-surgical: Alterations in digestion and bowel elimination ATI Medical-surgical nursing: chapters 46, 47, 48, 51 ATI Pharmacology: chapter 28 29 National library of medicine: StatPearls