GI Pharmacology and Nursing Intervention (F2024) PDF

Nursing 488 F2024 Catherine Fox, Bemi Lawal, Shelley de Boer, Hillary Selkirk, C. Seneviratne, K. Wollny, T. Ens, K. McCartney, Photo: Colourbox.com  For each drug classification, student is responsible to know pharmac...

Nursing 488 F2024 Catherine Fox, Bemi Lawal, Shelley de Boer, Hillary Selkirk, C. Seneviratne, K. Wollny, T. Ens, K. McCartney, Photo: Colourbox.com  For each drug classification, student is responsible to know pharmacology specifics based on Sealock & Seneviratne et al. (2021) text chapters assigned as reading: Generic Name/Trade Names Classification Indications Mechanism Of Action (pharmacokinetics – absorption, distribution, metabolism & excretion, half-life, Student onset/peak/duration) Preparation for Contraindications/Precautions Adverse Reactions/Side Effects N488 Class Toxicity & Management Of Overdose Interactions (drug-drug, food-drug) Route/Dosage Nursing Considerations – (Lab Values/Implementation/Planning for care/Assessment of nursing and pharmacological interventions) Nursing Interventions- will be discussed in class Patient and Family Teaching – will be discussed in class NEXT Class Objectives Develop an understanding of the nursing process across the lifespan for individuals with alterations in digestion: diarrhea, nausea & vomiting management. Explore, discuss and identify common pharmacological Acid-controlling drugs interventions in caring for Anti-emetics individuals with alterations in Laxatives & Antidiarrheals digestion, including: Overview of Common GI Disorders: GERD Gastritis Acute Upper gastrointestinal bleeding Peptic ulcer disease Stress ulcer Peritonitis Intestinal Obstruction Acute Pancreatitis Cholelithiasis and cholecystitis  constipation Diarrhea liver disease Crohn's disease and ulcerative 12/9/2024 colitis (IBD) Classifications: GI Drugs Acid Controlling Drugs:- Antacids Acid-reducing agents PPIs (Proton pump inhibitors) H₂ -receptor antagonists Antiemetics ondansetron, metoclopramide Laxatives Antidiarrheals Antispasmodics e.g., dicyclomine for IBS 12/9/2024 Acid- Related Pathophysiology The stomach secretes: Hydrochloric acid (HCl) Bicarbonate Pepsinogen (pepsin) Intrinsic factor Mucus Prostaglandins (anti inflammatory) Hyperacidity Acid Controlling Drugs-Antacids: Mechanism of Action:- Neutralize stomach acid Note Promote gastric mucosal defence mechanisms Secretion of: Mucus: protective barrier against HCl Antacids DO NOT prevent the overproduction of acid Bicarbonate: helps buffer acidic properties of HCl Antacids DO neutralize the acid Prostaglandins: once it is in the stomach prevent activation of proton pump  Used alone or in combination Aluminum salts: Types of Almagel (with magnesium hydroxide), Maalox and Mylanta Combination products (aluminum and Antacids magnesium balance out side effects) and Their Magnesium salts: Carbonate salt: Magmix Hydroxide salt: milk of magnesia Uses Oxide salt: magnesium oxide Trisilicate salt: Gasulsol Tablets Combination product: Calmax, Maalox Calcium salts Calcium carbonate (Tums). Bicarbonate: Benefits and Risks in Acid Control Sodium bicarbonate (Baking Soda): Is highly soluble Buffers the acidic properties of HCl Has a quick onset but short duration May cause metabolic alkalosis May cause problems in patients with heart failure, hypertension, or renal insufficiency because of high sodium content Antacids Known drug allergy Severe kidney failure or electrolyte Contraindicat disturbances (because of the potential toxic accumulation of electrolytes in the antacids themselves) ions Gastrointestinal obstruction Adverse effects are minimal and depend on the compound used Aluminum and calcium Adverse Constipation Magnesium Effects Diarrhea Calcium carbonate Produces gas and belching; combining it with simethicone reduces discomfort Antacids: Drug Interactions Altered Increased Increased Absorption stomach pH urinary pH Reduces Increased Increased the absorption excretion ability of of basic of acidic the other drugs drugs drug to be Decreased Decreased absorbed absorption excretion into the of acidic of basic body drugs drugs Antacids: Nursing Implications Assess for allergies and pre- Use with caution with other existing conditions that may medications due to the many drug restrict the use of antacids, such interactions as: Most medications should be given 1 Fluid imbalances to 2 hours after giving an antacid Pregnancy Antacids may cause premature Renal disease:- Patients with dissolving of enteric-coated heart failure or hypertension medications, resulting in stomach should not use antacids with a upset high sodium content Monitor for adverse effects Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound Monitor for therapeutic response Notify health care provider if symptoms are not relieved  Histamine- 2(H₂ ) Antagonists  Reduce acid secretion  Are available OTC in lower dosage forms  Are the most popular drugs for treatment of acid- related disorders › cimetidine (Tagamet) › famotidine (Pepcid) › nizatidine (Axid) › ranitidine (Zantac) Photo: Colourbox.com Histamine-2(H₂ ) Antagonists: Mechanism of Action Block histamine at the H2 receptors of acid-producing parietal cells Reduce production of hydrogen ions, resulting in decreased production of HCl Suppresses acid secretion in the stomach H₂ Antagonists: Indications Gastroesophageal Reflux Disease (GERD) Peptic Ulcer Disease (PUD) Erosive esophagitis Adjunct therapy in control of upper GI bleeding Pathological gastric hypersecretory conditions H₂ Antagonists ADVERSE EFFECTS DRUG INTERACTIONS Very few adverse Cimetidine binds with P-450 effects microsomal oxidase system in the liver, resulting in Cimetidine may induce inhibited oxidation of many impotence and drugs and increased drug gynecomastia levels Other possible All H2 antagonists may effects include: inhibit the absorption of Headaches, lethargy, drugs that require an acidic confusion, diarrhea, GI environment for absorption urticaria, sweating, flushing Smoking has been shown to decrease the effectiveness of H2 blockers H₂ Antagonists: Nursing Implications Assess for allergies and impaired renal or liver function Use with caution in patients who are confused or disoriented and in older adults Give 1 hour before or after antacids For intravenous (IV) doses, follow administration guidelines Proton Pump Inhibitors: Proton Pump:- The parietal cells release positive hydrogen ions (protons) during HCl production This process is called the “proton pump” H2 blockers and antihistamines do not stop the action of this pump Proton Pump Inhibitors (PPIs): Mechanism of Action Result: achlorhydria—ALL Proton gastric acid pump This bond secretion is inhibitors prevents the temporarily irreversib movement of blocked ly bind to hydrogen ions In order to. the. from the. return to normal acid hydrogen– parietal cell secretion, the potassium– into the parietal cell ATPase stomach must synthesize enzyme new hydrogen– potassium– ATPase Proton Pump Inhibitors (PPIs): Indications Gastroesophageal reflux disease (GERD): Reduces acid reflux into the esophagus. Peptic ulcer disease (PUD): Helps heal ulcers by reducing acid production. Zollinger-Ellison syndrome: Treats hypersecretion of acid caused by gastrin-secreting tumors. Erosive esophagitis: Reduces irritation and promotes healing of the esophagus. Nursing Implications Administration: Assess for allergies To be taken on an empty and history of liver disease stomach, usually before Pantoprazole is the meals to optimize only proton pump effectiveness inhibitor available for parenteral Short-Term Use: administration and can Usually recommended for be used in patients 4-8 weeks. Long-term use who are unable to take oral medications should be monitored to PPIs may increase prevent potential serum levels of complications diazepam or phenytoin and cause increased chance for bleeding Monitoring for Side with warfarin Effects: (Coumadin) PPIs often work best when taken 30 to 50 12/9/2024 minutes before meals Other Drugs Simethicone Sucralfate (Ovol, Misoprostol (Sulcrate) Pediacol, Phazyme) Sulcralfate (Sulcrate) Is a cytoprotective drug Is used for stress ulcers, PUD Is attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse) Absorbs little from the gut May cause constipation, nausea, and dry mouth May impair absorption of other drugs—give other drugs at least 2 hours before giving sucralfate Should not be administered with other medications Misoprostol Misoprostol is a synthetic prostaglandin analogue Prostaglandins have cytoprotective functions Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate Promote local cell regeneration Help to maintain mucosal blood flow Misoprostol is used for the prevention of nonsteroidal anti- inflammatory drug (NSAID)–induced gastric ulcers Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea Antiemetic/Anti- nausea Drugs Vomiting Centre (VC) and Chemoreceptor trigger zone (CTZ) ⃰ Both are located in the brain ⃰ Once stimulated, they cause the vomiting reflex (Sealock & Seneviratne, Antiemetic Drugs: Indications Specific indications vary per class of antiemetics General use for each type: prevention and reduction of nausea and vomiting Antiemetic drugs: Mechanism of Action (Sealock & Seneviratne, 2021)  (Sealock & Seneviratne, 2021) 12/9/2024 Mechanism of Action and indications Anticholinergic drugs Antihistamine drugs (H1 receptor Neuroleptic drugs ( Ach blockers) blockers Bind to and block Inhibit ACh by binding to H1 Block dopamine acetylcholine (ACh) receptors receptors on the CTZ receptors in the inner Prevent cholinergic stimulation ear labyrinth in vestibular and reticular Include olanzapine, Block transmission of areas, thus preventing nausea and prochlorperazine nauseating stimuli to vomiting (stemetil), CTZ chlorpromazine, Include dimenhydrinate (Dinate, promethazine Also block Gravol, Nauseatol, others), (Histanil), transmission of diphenhydramine (Aller-Aide, perphenazine, several nauseating stimuli Allerdryl, Benadryl), meclizine others from the reticular (Bonamine), promethazine formation to the VC (Histantil) Are also used for psychotic disorders, 12/9/2024 Are also used for motion intractable hiccups Mechanism of Action and indications Prokinetic drugs Serotonin blockers Tetrahydrocannabinoids Block dopamine in Block serotonin receptors Are a major psychoactive the CTZ in the GI tract, CTZ, and substance in marijuana Desensitize CTZ to VC Have inhibitory effects on impulses it receives Include ondansetron reticular formation, from the (Zofran), granisetron thalamus, cerebral cortex gastrointestinal (Kytril), Alter mood and body’s (GI) tract Are used for nausea and perception of its Also stimulate vomiting in patients surroundings peristalsis in GI receiving chemotherapy and Include dronabinol tract, enhancing for postoperative nausea (Marinol), nabilone emptying of stomach and vomiting (Cesamex) contents Are used for nausea and Include vomiting associated with metoclopramide (Apo- chemotherapy and anorexia Metoclop, 12/9/2024 maxeran, associated with weight loss Miscellaneous Antinausea Drugs: Mechanism of Action and Indications Aprepitant (Emend) acts as a selective antagonist at substance P/neurokinin 1 (NK1) receptors in the brain. Has little affinity for 5-HT3 (serotonin) and dopamine receptors. Indicated for acute and delayed chemotherapy induced nausea and vomiting, as well as postoperative nausea and vomiting. Inhibits cytochrome P450 enzyme system, caution must be used in giving it together with drugs that are primarily metabolized by this pathway.  Adverse Effects & Drug Interactions Antiemetic Drug Class Adverse Effects Interactions Serotonin blockers Headache, constipation No significant drug interactions Anticholinergics Dry mouth, constipation, Additive drying effects when given dry eyes with antihistamines and antidepressants. Antihistamines Drowsiness, dizziness, Increased CNS effects when given with blurred vision, dry mouth barbiturates, opioids, hypnotics, tricyclic antidepressants, or alcohol. Prokinetics Abdominal cramps, Combining metoclopramide with alcohol diarrhea, EPS can result in additive CNS depression. Neuroleptic drugs Sedative effects, EPS, Increased CNS depression effects are anticholinergic effects, seen with alcohol or other CNS orthostatic hypotension depressants. Tetrahydrocannabinoids Drowsiness, dizziness, No significant drug interactions dry mouth NK1 antagonist Dizziness, headache, Warfarin, oral contraceptives, and Nursing Implications Assess complete nausea and vomiting history, including precipitating factors Assess current medications Assess for contraindications and potential drug interactions Assess for effectiveness of the medication Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks Taking antiemetics with alcohol may cause severe central nervous system (CNS) depression Teach patients to change position slowly to avoid hypotensive effects Monitor vital signs regularly, especially with pt. taking medications like prochlorperazine (Stemetil), which can cause orthostatic hypotension and tachycardia When used in patients receiving chemotherapy, antiemetics are usually given an hour to 30 minutes before a chemotherapy drug Monitor for therapeutic effects Photo: Colourbox.com  Older adult patients experiencing nausea and vomiting require careful assessment and monitoring, Age- particularly during periods of fluid loss and subsequent rehydration related therapy. considerat They are more likely to have cardiac or renal insufficiency ions: which places them at greater risk for life-threatening fluid and Nausea and electrolyte imbalances. Excessive replacement of fluid and vomiting electrolytes may result in adverse consequences for the older adult person who has heart failure or renal disease. Antidiarrh eals Category: Antidiarrheals Adsorbents Activated charcoal, aluminum hydroxide, bismuth subsalicylate, cholestyramine, polycarbophil Antimotility agents Anticholinergic Atropine sulphate, hyoscyamine Opiates Opium tincture, paregoric, codeine phosphate, diphenoxylate, loperamide hydrochloride Probiotics and intestinal flora modifiers Latobacillus acidophilus, lactobacillus GG, saccharomyces boulardii 12/9/2024  Indications ACUTE DIARRHEA CHRONIC DIARRHEA TRAVELER'S SEVERE DIARRHEA DIARRHEA DUE TO SPECIFIC CONDITIONS 12/9/2024 Antidiarrheals: Mechanism of Action Adsorbents:  Antimotility drugs: anticholinergics Coat the walls of the Decrease intestinal muscle gastrointestinal (GI) tract tone and peristalsis of GI tract Bind to the causative Slow the movement of fecal bacteria or toxin, which is matter through the GI tract then eliminated through the Include belladonna alkaloids, atropine, hyoscyamine, stool hyoscine Include bismuth subsalicylate (Bismuth,  Antimotility drugs: opiates Decrease bowel motility and Maalox Multi Action, Pepto- relieve rectal spasms Bismol), activated charcoal, Decrease transit time through attapulgite (Kaopectate), the bowel, allowing more time for water and electrolytes to others be absorbed Reduce pain by relieving rectal spasms Include paregoric, opium tincture, codeine, loperamide (Imodium), diphenoxylate Antidiarrheals: Mechanism of Action Intestinal flora modifiers Are also known as probiotics or bacterial replacement drugs Are bacterial cultures of Lactobacillus organisms, which work by:  Supplying missing bacteria to the GI tract  Suppressing the growth of diarrhea-causing bacteria Include L. acidophilus Antidiarrheals: Combination products Diphenoxylate with atropine (Lomotil) diphenoxylate is combined with subtherapeutic amounts of atropine The addition of atropine discourages recreational opiate drug use Large dosages will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision) Antidiarrheals: Adverse Effects Adsorbents Anticholinergics Increased bleeding Urinary retention, time hesitancy, impotence Constipation, dark Headache, dizziness, stools confusion, anxiety, Confusion, drowsiness twitching Dry skin, rash, Hearing loss, flushing tinnitus, metallic Opiates Blurred vision, taste, blue gums photophobia, increased Drowsiness, sedation, intraocular pressure dizziness, lethargy Hypotension, Nausea, vomiting, anorexia, hypertension, constipation bradycardia, tachycardia Respiratory depression Bradycardia, palpitations, hypotension Urinary retention Flushing, rash, urticaria Antidiarrheals: Interactions Adsorbents decrease the absorption of many drugs, including digoxin, clindamycin, quinidine, hypoglycemic drugs, others Adsorbents cause increased bleeding time and bruising when given with anticoagulants Antacids can decrease effects of anticholinergic antidiarrheal drugs Many other interactions exist Antidiarrheals: Nursing Implications Patient will be on contact isolation. Perform hand hygiene as per protocol at the minimum. (Alcohol-based hand rubs are not effective against C.difficile spores). Obtain a thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies Do NOT give bismuth subsalicylate (Pepto-Bismol) to children or teenagers with chickenpox because of the risk of Reye’s syndrome Teach patients to notify their physician immediately if symptoms persist Monitor for therapeutic effects Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes Assess fluid volume status, intake and output, and mucous membranes before, during, and after initiation of treatment Constipat ion  Abnormally infrequent and difficult passage of feces Constipat through the lower GI tract Constipation is a symptom, not ion a disease It is a disorder of movement through the colon and/or rectum It can be caused by a variety of diseases or drugs Requires collaborative care and approaches (dietary, behavioural, and pharmacologic).  Categories of Laxative Drugs: CATEGORY EXAMPLE Bulk forming Psyllium, methylcellulose Emollient Docusate sodium, mineral oil Hyperosmotic Polyethylene glycol, lactulose, sorbitol, glycerin Saline Magnesium sulfate, magnesium phosphate, magnesium citrate Stimulant Senna, biscodyl (Sealock & Seneviratne, 2021) Laxatives: Mechanism of Action BULK-FORMING EMOLLIENT LAXATIVES LAXATIVES  Are high in fibre  Are also referred to as stool softeners and  Absorb water to increase bulk lubricants  Distend bowel to initiate reflex  Promote more water and bowel activity fat in the stools  Include:  Lubricate the fecal psyllium (Metamucil) material and intestinal methylcellulose (Entrocel solution) walls Polycarbophil  Include: Stool softeners: docusate salts (Colace) (removed from AHS formulary) Lubricants: mineral oil (Fleet Enema Mineral Oil)  Laxatives: Mechanism of Action Hyperosmotic laxatives  Increase fecal water content Saline Laxatives  Result in bowel distention, increased peristalsis, and Increase osmotic pressure evacuation within the intestinal tract, causing more water  Include: to enter the intestines Polyethylene glycol (PEG) (Klean-Prep, PegLyte) Result in bowel Sorbitol, glycerin distention, increased peristalsis, and Lactulose (also used to reduce evacuation elevated serum ammonia levels) Used for diagnostic and  Used for diagnostic and surgical prep and removal surgical prep of helminths and parasites. Stimulant Laxatives Saline laxatives include: Increase peristalsis magnesium sulfate (Epsom salts) via intestinal nerve magnesium hydroxide stimulation (milk of magnesia) Include: magnesium citrate (Citro-Mag, Citrodan) castor oil sodium phosphate senna (Senokot preparations) cascara sagrada bisacodyl  Laxatives: Drug Effects Drug Effect Bulk Emollient Hyperosmotic Saline Stimulant Increases Y Y Y Y Y peristalsis Causes Y Y N Y Y increased secretion of water and electrolytes in small bowel Inhibits Y Y N Y Y absorption of water in small bowel Increases N Y N N Y wall permeability in small bowel Acts only in N N Y N N large bowel Increases Y Y Y Y Y water in fecal mass Softens fecal Y Y Y Y Y (Table 40.5, Sealock & Seneviratne, 2021) mass Laxatives: Contraindications Drug allergy To be used with caution in the presence of the following: Acute surgical abdomen Appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted) Intestinal obstruction Undiagnosed abdominal pain  Laxatives: Adverse Effects **All Laxatives can cause Electrolyte imbalances** Hyperosmotic Bulk-forming Abdominal bloating Impaction Electrolyte Fluid overload imbalances Electrolyte imbalances Rectal Esophageal blockage irritation  Saline Emollient Magnesium toxicity Skin rashes (with renal Decreased absorption insufficiency) of vitamins Cramping Electrolyte Electrolyte imbalances imbalances Diarrhea Stimulant Increased thirst Nutrient malabsorption Skin rashes Rectal irritation Electrolyte imbalances Laxatives: Interactions Because laxatives alter intestinal function, they can interact with other drugs quite readily Each category can alter the effect of specific drugs Some laxatives may interact with food such as milk and juices Laxatives: Nursing Implications Obtain a thorough history of A healthy, high-fibre diet and presenting symptoms, elimination increased patterns, and allergies fluid intake should be encouraged as an alternative to laxative use Assess fluid and electrolytes before initiating therapy Long-term use of laxatives often results in decreased bowel tone Patients should not take a and may lead to dependency laxative or cathartic if they are experiencing nausea, vomiting, or All laxative tablets should be abdominal pain swallowed whole, not crushed or chewed, especially if enteric Patients should take all laxative coated tablets with 180 to 240 mL of water Bisacodyl and cascara sagrada should be given with water due to Patients should take bulk-forming interactions with milk, antacids, laxatives as directed by the and juices manufacturer with at least 240 mL of water Patients should contact their physician if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss. Monitor for therapeutic effects Disorders of the stomach and upper small intestines Gastritis Acute Upper gastrointestinal bleeding Peptic ulcer disease Stress Ulcers GERD Nursing Management: Gastroesophageal Reflux Disease (GERD) Teach patients to avoid factors that cause reflux: Smoking cessation Elevating head of bed 30 degrees Avoid lying down 2 to 3 hours after eating Avoid late-night eating Evaluate effectiveness and adverse effects of medications taken for heartburn Gastrit is Diagnostic studies Nursing Management of Acute gastritis Upper gastrointestinal bleeding Diagnostic Nursing implementation studies Health Promotion Acute intervention Collaborative Ambulatory and home care care Endoscopic Evaluation therapy Surgical therapy Drug therapy Acute Peptic Ulcer Disease and Stress Ulcers Diagnostic studies Collaborative care: Conservative and prophylactic therapy Drug therapy Histamine (H2)-receptor blockers Proton pump inhibitors Antibiotic therapy Antacids Anticholinergic drugs Cytoprotective drug therapy Other drugs Nursing Management: Peptic Ulcer Disease Nursing implementation Collaborative therapy: Surgical Health promotion therapy for peptic ulcer Acute intervention disease Hemorrhage Postoperative complications Dumping syndrome Perforation Gastric outlet Postprandial hypoglycemia obstruction Bile reflux gastritis Ambulatory and home care Nutritional therapy Evaluation Age-related considerations: Peptic ulcer disease Incidence in patients over 60 years of age is increasing. Related to increased use of NSAIDs In the older adult, pain may not be the first symptom associated with an ulcer. For some individuals, the first manifestation may be frank gastric bleeding (e.g., hematemesis, melena) or a decrease in hematocrit. Morbidity and mortality rates associated with gastric ulcers in the older adult are higher than those for younger adults because of concomitant health problems (e.g., cardiovascular, pulmonary) and a decreased ability to withstand hypovolemia. Other Common GI Disorders Acute Abdominal pain Abdominal Trauma Peritonitis Intestinal Obstruction Disorders of the Liver Hepatitis Acute Pancreatitis Cholelithiasis and cholecystitis 12/9/2024 Acute Abdominal pain Nursing Evaluation implementation Acute intervention Preoperative care Postoperative care Ambulatory and home care Abdominal Trauma Etiology and pathophysiology Clinical manifestations Diagnostic studies Nursing and Collaborative Management: Abdominal Trauma Emergency management focuses on establishing a patent airway and adequate breathing, fluid replacement, and prevention of hypovolemic shock. Intravenous (IV) lines are inserted, and volume expanders or blood is given if the patient is hypotensive. Peritonitis Diagnostic studies Collaborative care Nursing assessment Nursing diagnoses Planning Nursing implementation Intestinal Obstruction Types of intestinal obstruction Mechanical Nonmechanical (Lewis et al., 2019) Disorders of the Liver Viral hepatitis Nonalcoholic fatty liver Toxic and drug-induced disease and nonalcoholic hepatitis steatohepatitis Hepatitis Collaborative care Drug therapy goals Decrease viral load Decrease liver enzyme levels Decrease rate of disease progression α-Interferon Nucleoside and nucleotide analogs Nursing Management: Hepatitis Nursing implementation Health Promotion Hepatitis A Hepatitis B Hepatitis C Acute intervention Jaundice Nutrition Assessment Rest disease (NAFLD) and nonalcoholic steatohepatitis (NASH) Nonalcoholic fatty liver disease (NAFLD) A spectrum of disease that ranges from simple fatty liver that causes no hepatic inflammation to severe liver scarring Characterized by hepatic steatosis (accumulation of fat in the liver) not associated with other causes such as viral hepatitis, autoimmune disease, or alcohol Collaborative care  Cirrhosis of the liver Diagnostic studies Liver biopsy Noninvasive fibrosis markers Collaborative care Drug therapy Ascites Peritoneovenous shunt Albumin infusion Nursing management: Cirrhosis Nursing implementation Health Promotion Acute intervention Bleeding esophageal varices Ascites: Albumin infusion Hepatic encephalopathy: Lactulose Evaluation Acute Pancreatit is Diagnostic studies Collaborative care Conservative therapy Intervention therapy Surgical Therapy Drug therapy Nutritional therapy 12/9/2024  Cholelithiasis and cholecystitis Collaborative care Conservative therapy Cholecystitis Cholelithiasis Surgical therapy Transhepatic biliary catheter Drug therapy Nutritional therapy Nursing Management: Gallbladder Disease Nursing implementation Health promotion Acute intervention Postoperative care Evaluation (Lewis et al., 2019)  Nursing management: Abdominal surgery Assess patient on admission to the unit from OR for complications: atelectasis, hemodynamic instability, cognitive dysfunction, pain, fluid/electrolyte imbalance, fever/hypothermia, nausea/vomiting, urinary retention, and wound infection. Regular vital signs monitoring. Assist with deep breathing and coughing exercises. Help the patient with repositioning and ambulation. ERAS protocol Pain management. Wound care and dressing changes as ordered. Monitor I&O Patient education and discharge planning. 12/9/2024 12/9/2024 12/9/2024 12/9/2024 12/9/2024 12/9/2024  Practice Question 6: A patient is receiving A. The patient reports a recent history of loperamide constipation. (Imodium) for diarrhea. Which B. The patient has a fever condition would of 38.6°C and bloody prompt the nurse stools. to hold the C. The patient has a medication and history of irritable bowel notify the syndrome (IBS). physician? D. The patient is experiencing mild abdominal 12/9/2024 cramping.