Gastrointestinal Med Surg PDF

Gastrointestinal Bowel Obstruction 2 types: mechanical (caused by an object) or non-mechanical (paralytic ileus) Small Bowel Obstruction Causes: hernia, abd surgery, adhesions S/sx: cramping, n/v, pain is mid-abdominal, severe constipation NI: NPO, IV fluids, I&O’s, NG-tube w/ low suction,...

Gastrointestinal Bowel Obstruction 2 types: mechanical (caused by an object) or non-mechanical (paralytic ileus) Small Bowel Obstruction Causes: hernia, abd surgery, adhesions S/sx: cramping, n/v, pain is mid-abdominal, severe constipation NI: NPO, IV fluids, I&O’s, NG-tube w/ low suction, pain management Large Bowel Obstruction Medical emergency - risk for intestinal rupture S/sx: lower abdominal pain, n/v, diarrhea, constipation, no appetite NI: NPO, IV fluids, I&O’s, NG-tube w/ low suction, pain management Colostomy Operation where a pt’s colon is diverted to an opening in the abdominal wall; temporary or permanent NI: assess skin integrity around stoma, clean stoma with warm water and pat dry, prevent liquid stool in bag from overflowing, teach colostomy care Dumping Syndrome Can develop after stomach surgery and causes abdominal pain Increase consumption of fats and proteins, eat small meals, lie down after meals, wait 1 hr after meals to drink liquids Hiatal Henria Part of stomach bulges through the diaphragm, causing heartburn and abd pain NI: eat small frequent meals, eliminate foods that worsen symptoms, have pt sit upright for one hour after eating, place pt in Fowler or semi-Fowler position (to reduce regurgitation) Hiatal Hernia Peptic Ulcer Disease (PUD) Sore in the mucosal wall of the GI tract; can be caused by H. pylori Coffee brown emesis Duodenal → melena stool Gastric → hematemesis NI: Monitor stools and test for occult blood, give meds and mucosal healing agents, give small frequent meals Gastroesophageal Reflux Disease (GERD) Regurgitation of stomach acid into the esophagus, causing heartburn, dysphagia, chest pain Pain typically occurs after eating and worsens when lying down Pt should avoid triggers: spicy food, caffeine, chocolate, citrus fruits NI: encourage small frequent meals, teach pt to stop eating 3 hours before bed, give H2 antagonists, PPI, antacids Closed sphincter Open sphincter Esophageal Varices Enlarged veins in esophagus; occurs when blood flow to liver is blocked by the portal vein NI: maintain open airway, monitor for rupture and hemorrhage, suction if needed Management: insertion of esophagogastric balloon tamponade, coagulation factors, vitamin K, vasopressors Stoma Opening on the abdomen; should be pinkish Dark/Dusky stoma = poor blood supply Black = necrosis Protruding = prolapsed  Gastrointestinal Crohn’s Disease Inflammation of digestive tract causing abdominal pain, diarrhea, malnutrition, weight loss Diet should be low fat, high protein, no dairy or spicy foods NI: monitor I&O and electrolytes, track weights, assess bowel patterns, educate pt to avoid alcohol, smoking, and caffeine Ulcerative Colitis Inflammation of large intestine and rectum that causes liquid stools (blood & mucus), abdominal pain, rectal bleeding, anemia, fatigue NI: refer to Crohn’s Cirrhosis Liver damage which causes scarring and liver failure; causes jaundice and palpable liver Labs: elevated ammonia Slows metabolism of drugs, so they linger in the body Causes: hepatitis and chronic alcohol use NI: give ADEK vitamins, assess mental status, avoid anything that could cause bleeding, give lactulose (excretes ammonia), daily weights, monitor I&O, monitor protein intake Hepatitis Pancreatitis Caused by digestive juices or enzymes attacking the pancreas Signs - Cullen and Turner’s sign Cullen sign - discoloration of umbilical area, Turner’s sign - bruising of the flanks NI: Place patient in knee-chest position (decrease pain), NPO, typically will be placed on gut rest and need a PICC for TPN/lipids Cholecystitis Gallbladder inflammation d/t the buildup of bile in the gallbladder Causes cholelithiasis (gallstones), which blocks bile from being excreted S/sx: n/v, epigastric pain that radiates to right scapula after eating high fat foods, RUQ pain, rebound tenderness, jaundice, Murphy’s sign, guarding NI: NPO, IV fluid, abx, anticholinergics, pain control Enema Monitor for water intoxication (signs/symptoms: weakness, pallor, dizziness, diaphoresis) Additional Notes: Stopping TPN abruptly → hypoglycemia Injured hepatic cells release AST and ALT. High levels of AST & ALT = liver injury or disease