GI Disorders - Student Copy PDF

INFLAMMATION GASTROINTESTINAL DISORDERS MAXINE E. HYLTON. MSN-ED, RN  Learning Objectives Understand the pathophysiology, clinical manifestations, and complications of GERD, PUD, Acute and chronic Gastritis, Diverticulitis, and IBS....

INFLAMMATION GASTROINTESTINAL DISORDERS MAXINE E. HYLTON. MSN-ED, RN  Learning Objectives Understand the pathophysiology, clinical manifestations, and complications of GERD, PUD, Acute and chronic Gastritis, Diverticulitis, and IBS. Describe the nursing and medical management for each gastrointestinal condition. Identify common surgical interventions and postoperative care for severe cases.. Identify the diagnostic tests used to evaluate gastrointestinal tract function and related nursing implications.. Recognize and evaluate the major symptoms of gastrointestinal dysfunction by applying the patient’s health history and physical assessment findings.  NCLEX  Safe and Effective Care Environment  Health Promotion and Maintenance  Physiological Integrity  Psychosocial Integrity CONCEP Inflammation T EXEMPLA Gastritis Peptic Ulcer Disease (PUD) Gastroesophageal Reflux Disease RS (GERD) Irritable Bowel Syndrome (IBS) Diverticulitis Gastro-inflammatory Disease Inflammatory Bowel Disease The concept of inflammation Inflammation is central to understanding gastrointestinal (GI) conditions like Inflammatory Bowel Disease (IBD), Gastroesophageal Reflux Disease (GERD), Peptic Ulcer Disease (PUD), gastritis, and diverticulitis. In each of these conditions, inflammation plays a distinct role in both the pathophysiology and symptomatology which directly impacts treatment approaches and nursing management. Introduction Anatomy Patient Education Diagnostics Pharmacological Management Understanding the Empowering patients Accurate diagnosis is structure of the with knowledge about crucial for effective Understanding gastrointestinal (GI) their conditions and treatment and different medications tract helps us treatments improves management of GI used to treat GI understand how their health outcomes. disorders. disorders helps us conditions affect it. provide effective nursing care. Inflammation in Gastrointestinal Disorders Inflammation is a natural response to injury or infection. It can be a symptom of a variety of gastrointestinal disorders. We'll discuss the role of inflammation in different digestive conditions. GI Disorders: This presentation will explore common gastrointestinal (GI) disorders, drawing from Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition. We will delve into the pathophysiology, clinical manifestations, diagnostics, nursing assessment and interventions, of these conditions. Gastritis and Inflammation Gastritis is inflammation of the stomach lining. It can be acute, caused by infection or medications, or chronic, often associated with Helicobacter pylori infection. Acute Gastritis Chronic Gastritis Often caused by alcohol Associated with H. pylori abuse, NSAIDs, or infections, infection, autoimmune and symptoms resolve with disorders, or prolonged use of treatment. certain medications. Symptoms Treatment Symptoms include abdominal Treatment involves addressing pain, nausea, vomiting, and the underlying cause and may loss of appetite. include medications to protect the stomach lining.  Manifestations of Gastriti Acute Gastritis Chronic Gastritis Epigastric pain Fatigue Dyspepsia Pyrosis Anorexia. Belching Hiccups Sour taste in the Nausea mouth Vomiting Halitosis Erosive gastritis Early satiety can lead to melena, Anorexia. hematemesis or Nausea and vomiting hematochezia May have pernicious anemia due to malabsorption of B12 Some are asymptomatic Diagnostic Tests for Gastritis A doctor may perform a physical exam to help diagnose gastritis, listening for bowel sounds and checking for signs of dehydration. In addition to a physical exam, a doctor may also order tests to diagnose gastritis. These tests may include a stool test to check for blood, a blood test to check for infection, and a biopsy to determine the cause of the gastritis. If the doctor suspects an infection, they may order a culture to identify the specific bacteria or virus causing the infection.  Managing Gastritis 1 Lifestyle Modifications 2 Medications 3 Antibiotics Nursing Care for Gastritis Patients Assessment Pain Management Nutritional Guidance Lifestyle Modifications  Medical Management of Gastritis Acute Chronic Refrain from Modify diet, alcohol and food promote rest, until symptoms reduce stress, subside avoid alcohol and Supportive NSAIDs therapy: IV fluids, Pharmacologic nasogastric therapy including intubation, medications antacids, (Table 40-2) histamine-2 Nursing Management of Gastritis Reduce anxiety; use calm 1 approach and explain all procedures and treatments Promote optimal nutrition; for acute gastritis, the client should take no 2 food or fluids by mouth.. Introduce clear liquids and solid foods as prescribed. Evaluate and report symptoms. Discourage caffeinated beverages, alcohol and cigarette Promote fluid smoking. Referbalance; monitor for alcohol counseling 3 I&O,smoking and for signscessation of dehydration,. electrolyte imbalance, and hemorrhage. 4 Measures to relieve pain: Diet and medication Patient Education for Gastritis Lifestyle Changes Avoid alcohol and tobacco. Eat smaller, frequent meals. Avoid spicy and acidic foods. Manage stress. Medication Adherence Take prescribed medications as directed. Antacids help reduce stomach acid. Antibiotics treat bacterial gastritis.  PUD Client Assessment History including presenting signs and symptoms Dietary history and dietary associations with symptoms such as predictable time for pain 72-hour diet; diary may be helpful. Abdominal assessment, vital signs Medications; include use of NSAIDs Sign and symptoms of anemia or bleeding Abdominal assessment Reprinted with permission from Strayer, D. S., Saffitz, J. E., & Rubin, E. (2015). Rubin’s pathology: Mechanisms of human disease (8th ed., Fig. 19-23). Philadelphia, PA: Lippincott Williams & Wilkins. Peptic Ulcer Disease (PUD) Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus Associated with infection of H. pylori Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency Manifestations include a dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occur Treatment includes medications (Table 40-3), lifestyle changes, and occasionally surgery (Table 40-4) Symptoms of PUD ✓ Pain ✓ Heartburn ✓ Nausea ✓ Bloating Diagnostic Tests for PUD Diagnosing peptic ulcer disease (PUD) involves a combination of: Medical history. Physical examination. Diagnostic tests: Upper endoscopy Stool occult blood test Breath test Barium Swallow Managing PUD Pharmacological management of Peptic Ulcer Disease (PUD) includes medications to reduce stomach acid and protect the stomach lining. Commonly prescribed medications include proton pump inhibitors (PPIs), H2 receptor antagonists like and antacids. Reduce Stomach Acid 1 Protect Stomach Lining 2 3 Eradicate H. pylori 3 ______________________________________________________ 4 Lifestyle modifications Nursing Care for PUD Clients Assessment Education Assess pain levels, Educate patients on medication adherence, and lifestyle modifications, dietary compliance. Monitor including diet, smoking for signs of complications cessation, and stress such as bleeding or management. Explain perforation. medication use and side effects. Pain Management Monitoring Administer pain medications Monitor vital signs, as ordered and provide gastrointestinal function, comfort measures, such as and response to medication. positioning and relaxation Assess for signs of bleeding techniques. and report any abnormalities to the physician. Patient Education for PUD Lifestyle Modifications Medications 1. Patients should avoid foods and drinks that 1.Patients should understand the purpose and irritate their stomach, such as spicy foods, dosage of their medications. alcohol, and caffeine. 2. They should also be aware of potential side 2. Eating smaller, more frequent meals can help effects and interactions with other reduce acid production. medications or supplements. 3. Regular follow- 3. Patients should also avoid smoking, which up with their healthcare provider is crucial increases the risk of PUD. for monitoring progress and adjusting medication as needed. Gastroesophageal Reflux Disease (GERD) GERD is a chronic condition where stomach acid or bile flows back up into the esophagus, causing heartburn, chest pain, and other symptoms. Gastroesophageal Reflux Disease (GERD) and Inflammation GERD occurs when stomach acid flows back into the esophagus, irritating the lining. This chronic condition can cause inflammation, leading to heartburn, indigestion, and esophageal damage. 1 Symptoms 2 Causes Common symptoms include Causes include a weakened heartburn, regurgitation, and lower esophageal sphincter, chest pain. hiatal hernia, and lifestyle factors like obesity and smoking. 3 Treatment 4 Complications Treatment options include Chronic inflammation can lead lifestyle modifications, to Barrett's esophagus, a medications, and in severe precancerous condition. cases, surgery. Diagnostic Tests for GERD Diagnosing GERD involves ruling out other conditions and assessing the severity of reflux symptoms. 1 Upper Endoscopy 2. Biopsy 3 Esophageal Motility Studies 4 Ambulatory Acid Monitoring Managing GERD Lifestyle Changes 1 Medications 2 Surgery 3  Medication Management for GERD Medication Treatment Therapeutic actions Selectively block H2 receptors Histamine-2 (H2) Prevents about 70% of hydrochloric acid release Antagonists Decreases pepsin production Indications Short-term treatment of active duodenal ulcer or Histamine-2 (H2) benign gastric ulcer Treatment of pathological hypersecretory Antagonists conditions such as Zollinger–Ellison syndrome Prophylaxis of ulcers induced by stress or NSAID use and acute upper GI bleeding in critical patients Treatment of erosive GERD Treatment of ulcers caused by H. pylori Relief of symptoms of heartburn and indigestion  Medication Management for GERD Block the release of hydrochloric acid in Histamine-2 (H2) response to gastrin Drugs Antagonists Cimetidine Famotidine Nizatidine Oral formulations available as OTC medications Suppress secretion of hydrochloric acid into the lumen of the stomach Proton Pump Drugs Omeprazole Inhibitors Esomeprazole Lansoprazole Dexlansoprazole Pantoprazole Rabeprazole Indications Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease Long-term treatment of pathological hypersecretory conditions Maintenance therapy for erosive esophagitis and ulcers Nursing Care for GERD Patients Pharmacological Lifestyle Management Modifications Patient Education Symptom Monitoring Management of GERD Lifestyle Sleep Habits Modifications Avoid caffeine, Elevate the head of tobacco, beer, milk, the bed by at least foods containing 30 degrees peppermint or spearmint, and carbonated beverages Dietary Changes Medications Low-fat See Table 39-4 for a diet list of medications commonly used to manage GERD Irritable Bowel Syndrome (IBS) Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Symptoms include cramping, abdominal pain, bloating, gas, diarrhea, and constipation. The exact cause of IBS is unknown, but it is thought to be a combination of factors, including genetics, gut bacteria, and stress.  Symptoms of IBS Bloating and Gas Abdominal Pain Nausea and Changes in Bowel Vomiting Habits Assessment and Diagnostic Findings of Irritable Bow Stool studies Contrast radiography studies Proctoscopy Barium enema Colonoscopy Manometry Electromyography Managing IBS Lifestyle Modifications Dietary changes can significantly improve symptoms. This can include avoiding trigger foods, consuming a high-fiber diet, and managing stress. Pharmacological Interventions There are various medications available to manage IBS symptoms. Antidiarrheals, laxatives, and antispasmodics are commonly prescribed. Alternative Therapies Acupuncture, yoga, and herbal remedies are alternative therapies that can be helpful for some individuals. Therapy Cognitive-behavioral therapy (CBT) is an effective approach to managing IBS symptoms by addressing stress and an Nursing Care for IBS Patients 1 Pain Management 2 Dietary Modifications Administer analgesics for pain relief. Help Educate patients on patients find diet modifications, comfortable including fiber and positions. food diary management. 3 Stress Reduction 4 Lifestyle Changes Teach stress Encourage regular reduction techniques, exercise, adequate such as relaxation sleep, and smoking exercises and cessation. mindfulness. Patient Education for IBS Dietary Modifications Stress Management Educate patients about the role of diet in IBS Emphasize the connection between stress and IBS. symptoms. Encourage stress-reducing techniques like Discuss the low FODMAP diet and other dietary exercise and mindfulness. strategies. Malabsorption The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients Conditions Disorders that Mucosal Postoperative cause (transport) Infectious disease Luminal disorders malabsorption malabsorption of disorders specific nutrients  Clinical Manifestations of Malabsorption Hallmark finding is diarrhea or frequent, loose, bulky, foul-smelling stools, high-fat content, and often grayish Symptoms similar to irritable bowel syndrome Manifested by weight loss and vitamin and mineral deficiency Assessment and Diagnostic Findings of Malabsorption Fat analysis Lactose tolerance tests D-xylose absorption tests Schilling tests Hydrogen breath test Endoscopy with biopsy Ultrasound, CT, radiography CBC, pancreatic function tests  Client Education Malabsorption Consider Vitamin Risk of Dietary fluid and replacemen Probiotics osteoporosi therapy electrolyte t s imbalance Diverticulitis and Inflammation Diverticula Small pouches in the colon. Inflammation Caused by trapped stool, bacteria, or other factors. Symptoms Abdominal pain, fever, nausea, and changes in bowel habits. Treatment Treatment typically involves antibiotics, a liquid diet, and pain relief.  Symptoms of Diverticulitis Abdominal Pain Nausea and Vomiting Fever Changes in Bowel Habits Diagnostic Tests for Diverticulitis  A physical exam, medical history, and a thorough evaluation of symptoms play a crucial role.  Imaging studies such as a CT scan or barium enema are used to visualize the colon and identify inflamed diverticula.  Blood tests help to assess inflammation and infection, while stool samples can rule out other conditions.  Additionally, colonoscopy may be recommended to further evaluate the colon and rule out other possibilities. Managing Diverticulitis Initial Management 1 Rest and hydration are key. Medications 2 Antibiotics, pain relievers, and antispasmodics. Dietary Changes 3 High-fiber diet, avoiding foods that irritate the gut. Surgery 4 For severe cases or recurring diverticulitis. Nursing Care for Diverticulitis Patients Assessment and Monitoring Dietary Management Medication Administration Patient Education Patient Education for Diverticulitis 1 1. Diet 2 2. Exercise Encourage patients to follow a high-fiber Regular exercise can help promote regular diet to help prevent diverticulitis. bowel movements and prevent constipation. 3 3. Hydration 4 4. Early Intervention Staying hydrated is important for Encourage patients to seek medical maintaining gut health and preventing attention if they experience any symptoms constipation. of diverticulitis.  Conclusion and Key Takeaways Inflammation is a common factor in many gastrointestinal disorders. Understanding the role of inflammation can help nurses provide effective care and support for patients experiencing these conditions. GERD 1 Inflammation caused by acid reflux. 2 PUD Inflammation associated with H. pylori infection. Gastritis 3 Inflammation of the stomach lining. 4 Diverticulitis Inflammation of diverticula in the colon. IBS 5 Inflammation may play a role in symptoms. 6 Postoperative Inflammation is part of the healing process.