NMC 116 Lecture: Gastrointestinal Disorders - PDF

NMC 116 LECTURE Nutritional-Metabolic Patterns/Responses to Altered Nutrition Disturbances in Ingestion ❖​ Gastroesophageal Reflux (GERD) ❖​ Hiatal Hernia ❖​ Achalasia Gastroesophageal Reflux (GERD) ➔​ Backflow of gastric or duodenal contents into the esophagus causing troubl...

NMC 116 LECTURE Nutritional-Metabolic Patterns/Responses to Altered Nutrition Disturbances in Ingestion ❖​ Gastroesophageal Reflux (GERD) ❖​ Hiatal Hernia ❖​ Achalasia Gastroesophageal Reflux (GERD) ➔​ Backflow of gastric or duodenal contents into the esophagus causing troublesome symptoms and or mucosal injury to the esophagus. ➔​ The backflow of gastric or duodenal Clinical manifestations: contents or both, past the LES, into the ​ Pyrosis (heartburn - burning sensation esophagus, without associated belching in the esophagus) or vomiting. Reflux may or may not ​ Dyspepsia - indigestion cause symptoms or abnormal changes. ​ Regurgitation ➔​ Persistent reflux may cause reflux ​ Dysphagia- from esophageal spasm, esophagitis. stricture or esophagitis and bleeding ➔​ Acid backflow from stomach into ​ Hypersalivation esophagus ​ Esophagitis Risk Factors Most common feature is HEARTBURN ​ Weak LES Other symptoms: ​ Obesity ​ Odynophagia- pain when swallowing, ​ Pregnancy which may be followed by a dull ​ Hiatal Hernia substernal ache from severe, long term ​ Smoking reflux ​ Rarely, nocturnal regurgitation wakes Causes: reflux occurs when LES pressure is the patient with coughing, choking, and deficient. or when pressure within the stomach a mouthful saliva exceeds LES pressure. Assessment and Diagnostic Findings: 1.​ Endoscopy ​ Incompetent lower esophageal sphincter 2.​ Barium swallow - evaluate the damage ​ Pyloric stenosis -opening between the to esophageal mucosa stomach and small intestine thickens 3.​ Esophageal pH monitoring ​ Hiatal hernia - a nordition in which part 4.​ Manometry- assess ability of esophagus of the stomach pushes up through the to squeeze food down diaphragm muscle ​ Motility disorder Management: Goal: avoid situations that decrease lower Predisposing factors: esophageal sphincter pressure or cause ​ Pyloric surgery which allows reflux of esophageal irritation. bile or pancreatic juice ​ Low fat, high fiber diet ​ Long term Ng tube (more than 5 days) ​ Avoid caffeine, tobacco, beer, milk, ​ Any agent that decrease LES pressure foods containing peppermint, such as food, alcohol, cigarettes, carbonated beverages anticholinergics, and other drugs ​ Avoid eating or drinking 2 hours before ​ Any condition or position that increases bedtime intra abdominal pressure ​ Maintain normal body weight or advise proper weight reduction Associated factors: ​ Avoid tight-fitting clothes ​ Tobacco use ​ Elevate the head of the bed at least 30 ​ Coffee drinking degrees. ​ Alcohol consumption ​ Administer prescribed h2 blockers, PPI ​ H. pylori - gastric infection ​ Surgery - laparoscopic Nissen Fundoplication (wrapping of a portion of the gastric fundus around the sphincter area of the esophagus). Ann Marie Peñafiel BSN 3F NMC 116 LECTURE Management: ​ Frequent small feeding ​ Not to recline for 1 hour after eating or avoid supine position - prevent reflux or movement of the hernia ​ Elevate the head of the bed -4-8 inches - prevent the hernia from sliding upward. Achalasia ➔​ A rare disorder that affects the esophagus, the tube that carries from Types: the mouth. In this condition the Lower Sliding esophageal sphincter (LES), which is a ​ (Type 1 - most common) occurs when ring of muscle at the junction of the the upper stomach and the esophagus and stomach, fails to relax gastroesophageal junction are displaced properly. This leads to difficulty in the upward and slide in and out of the passage of food and liquids into the thorax. stomach. ​ The stomach and part of the esophagus ➔​ Absent or ineffective peristalsis of the slide up into the chest through the distal esophagus accompanied by diaphragm. This type may cause failure of the esophageal sphincter to symptoms like heartburn and relax in response to swallowing regurgitation, especially when lying ➔​ Narrowing of the esophagus above the down. stomach resulting in gradual increased dilation of the esophagus in the upper Paraesophageal hernia chest. the esophagus muscles do not ​ All part of the stomach pushes through contract properly and do not help propel the diaphragm beside the esophagus. food down toward the stomach. ​ This less common type occurs when part of the stomach pushes through the Clinical Manifestations: diaphragm next to the esophagus, while ​ Dysphagia (solids/liquids) the esophagus stays in its normal ​ Heartburn position. This type can be serious, as it ​ Regurgitation can lead to complications such as ​ Weight loss ingulation of the stomach, which ​ Coughing and choking requires surgical intervention. ​ Non-cardiac chest or epigastric pain ​ Note: aspiration of gastric content - Clinical Manifestations: pulmonary complications ​ Pyrosis ​ Regurgitation Causes ​ Dysphagia ​ The exact cause of achalasia is not fully ​ Vague symptoms - intermittent understood, but it is believed to involve epigastric pain or fullness after eating. damage to the nerve cells in the esophagus, particularly the myenteric Complications: plexus, which controls the muscles of ​ Hemorrhage the esophagus and LES. This damage ​ Obstruction impairs the normal function of the LES, ​ Strangulation preventing it from relaxing properly. Assessment and Diagnostic Findings: Assessment and Diagnostic Findings: 1. X-ray studies 1.​ X-ray - esophageal dilation above the ​ barium swallow and fluoroscopy narrowing at the gastroesophageal ​ Esophagogastroduodenoscopy - junction passage of a fiber optic tube through 2.​ Barium swallow mouth into the digestive system for 3.​ CT scan visualization of the esophagus, 4.​ Endoscopy stomach, small intestine. 2. Chest CT scan Management: ​ Eat slowly and drink fluids with meals. Ann Marie Peñafiel BSN 3F NMC 116 LECTURE ​ Calcium channel blockers and nitrates - ​ Stress related gastritis -due to acute decrease esophageal pressure and illness improve swallowing. ​ Etiology: Acute- bacteria, irritating ​ Botulinum toxin (Botox) injection - foods, NSAIDS, alcohol, bile and quadrants of the esophagus - inhibits radiation the contraction of smooth muscle slows 2. Chronic - result from repeated exposure to the release of neurotransmitters irritating agents. (acetylcholine- an excitatory mediator), ​ develop to peptic ulcers, gastric chemical messengers that signal muscle carcinoma and gastric mucosa contraction associated lymphoid tissue lymphoma. ​ Pneumatic dilation - stretch the ​ Etiology: Chronic- Ulceration, bacteria, narrowed area of the esophagus Autoimmune disease, diet, alcohol, ​ Esophagomyotomy - cutting the smoking. esophageal muscle fibers ​ Endoscopic myotomy -(per-oral Classification: endoscopic myotomy) 1.​ Erosive - caused by local irritants (aspirin, other NSAIDs - Disturbances in Digestion Ibuprofen),alcohol consumption, gastric ❖​ Nausea and Vomiting radiation therapy. ❖​ Gastrointestinal bleeding 2.​ Non-erosive - caused by infection ❖​ Gastritis H.pylori ❖​ Peptic Ulcer Note: ​ Ingestion of strong acid/alkali causes Nausea and Vomiting the mucosa to be gangrenous or ➔​ Nausea - uneasiness in the stomach or perforate. uncomfortable feeling in the back of the ​ Scarring can occur resulting in pyloric throat. stenosis: narrowing)or obstruction. ➔​ Vomiting - forcible emptying of stomach contents through your mouth Clinical Manifestations: (Acute ➔​ Note: nausea and vomiting are not a Gastritis) disease but symptoms of many different ​ Epigastric pain conditions (gastroenteritis, food ​ Dyspepsia (indigestion) poisoning, motion sickness, pregnancy, ​ Headache migraines) ​ Anorexia ​ Hiccups Management of Nausea: ​ Nausea and vomiting 1.​ Drinking of clear or ice cold drinks 2.​ Eating light, bland foods (saltine crackers or plain bread) Erosive gastritis: 3.​ Avoiding fried, greasy or sweet foods ​ Bleeding 4.​ Eat and drink slowly and small frequent ​ Blood in vomitus meals. ​ Melena (tarry stools) 5.​ Not mixing hot and cold drinks ​ Hematochezia (bright red, bloody stools) ​ Systemic symptoms: Possible signs of Management of Vomiting: shock: 1.​ Drink gradual large amount of clear liquids Clinical Manifestations: (Chronic 2.​ Avoiding solid food until the vomiting Gastritis) episode has passed. ​ Belching 3.​ Rest ​ Early satiety ​ Intolerance of spicy and fatty foods ​ Complications: dehydration ​ Nausea and vomiting ​ Pyrosis Gastritis ​ Sour taste in mouth ➔​ Inflammation of gastric or stomach ​ Vague epigastric discomfort relieved by mucosa eating ​ Systemic symptoms: Anemia and fatigue -Vit B12 is not absorbed due to Types: diminished production of intrinsic factors 1.Acute - last for several hours - few days by the stomach of parietal cells.) Ann Marie Peñafiel BSN 3F NMC 116 LECTURE Clinical manifestations: Assessment and Diagnostic Findings: ​ dull, gnawing pain or burning ​ Endoscopy and biopsy sensation-mid epigastrium or back ​ СВС ​ Pyrosis and vomiting ​ Urea breath test ​ Constipation/diarrhea ​ Bleeding - hematemesis vomiting of Medical Management: blood), melena (black tarry stools) ​ Refrain form alcohol and food until ​ Peptic ulcer perforation - severe, sharp symptoms subside upper abdominal pain referred to ​ non-irritating diet / bland diet shoulder, abdominal tenderness, ​ Drugs (antacids, histamine-2 fecéptor nausea, vomiting, hypotension, antagonists - Famotidine, proton pump tachycardia (hypovolemic shock) inhibitors-omeprazole) ​ Characteristics of pain between gastric ​ Inform the need for Vitamin B12 and duodenal ulcers. injection if deficiency is present ​ IVF ​ Surgery - gastrojejunostomy Gastric Ulcer Duodenal Ulcer (anastomosis of jejunum to stomach to detour around the pylorus) Occurs immediately Occurs 2-3 hours after eating after meal Nursing Management: 1. Reduce anxiety awake paim during 2. Promoting optimal nutrition night A.​ IVF Cant express relief Relief of pain after B.​ No intake of caffeinated beverages - of pain after or eating or antacid stimulant that increases gastric activity antacid and pepsin secretion C.​ Stop smoking - nicotine reduces the Assessment and Diagnostic Findings: secretion of pancreatic bicarbonate, ​ Pain which inhibits the neutralization of ​ Epigastric tenderness/abdominal gastric acid in duodenum distention D.​ Promoting fluid balance ​ Upper endoscopy E.​ Relieve pain -preferred procedure F.​ Monitor for signs of complications like -allows direct visualization of inflammatory bleeding, obstruction and pernicious changes, ulcers and lesions, biopsy. anemia ​ СВС ​ Occult blood test Peptic Ulcer Disease ​ Gastric secretory studies - diagnose ➔​ Excavation that forms in the mucosa of ZES angonn achlorhydria the stomach in the pylorus, duodenum or esophagus. Surgical Management: ➔​ An ulceration of the gastric and ​ indicated for life threatening duodenal lining hemorrhage, perforation or obstruction ➔​ May be referred as to location as ​ Pyloroplasty - transecting nerves that Gastric ulcer in the stomach, or stimulate acid secretion and opening the Duodenal ulcer in the duodenum pylorus ➔​ Most common Peptic ulceration: anterior ​ Antrectomy - removal of pyloric (antrum) part of the duodenum. portion of the stomach with anastomosis to either duodenum Risk factors: (gastroduodenostomy or Billroth 1) or ​ H. pylori bacteria jejunum (gastrojejunostomy Billroth 11) ​ Long term NSAID use ​ Stress Nursing Interventions: ​ Smoking ​ Relieve pain - avoid aspirin and other ​ Alcohol abuse NSAID's ​ ZES - Zollinger-Ellison syndrome - ​ Reduce anxiety benign or malignant tumors in pancreas ​ Maintain optimal nutritional status and duodenum that secrete excessive ​ Monitoring and managing potential amounts of hormone gastrin complications Ann Marie Peñafiel BSN 3F NMC 116 LECTURE ​ Diet - low fiber and fluid intake Sign and symptoms of perforation: ​ Inability to increase intra-abdominal ​ Sudden, severe upper abdominal pain pressure to facilitate passage of stool ​ Vomiting (e.g. spinal cord injury) ​ Fainting ​ Lack of exercise ​ Boardlike abdomen ​ Stress-filled life ​ Hypotension and tachycardia - shock Pathophysiology: Interference with one of major functions of the Post-operative Nursing management colon such as: ​ Monitor VS 1.​ Mucosal transport ​ Post-op position: FOWLER'S 2.​ Myoelectric activity ​ NO until peristalsis returns 3.​ Process of defecation ​ Monitor for bowel sounds ​ Monitor for complications of surgery The urge to defecate is ignored ​ Monitor I and O, IVF | ​ Maintain NGT rectal mucous membrane and musculature ​ Diet progress: clear liquid → full liquid become insensitive to the presence of fee → bland meals masses ​ Manage DUMPING SYNDROME | stronger stimulus is required to produce peristaltic rush for defecation. | GASTRIC DUODENAL Due to fecal retention irritability of the colon Older Younger | spasm after meals Normal Acidity INCREASED acidity | colicky mid abdominal or low abdominal Pain early after eating Pain late after eating ins. (2-4 hours) | WORSENS by food, RELIEVES by food colon loss muscular tone RELIEVED by | VOMITING unresponsive to norm Bleeding, weight loss Less likely bleeding and vomiting and vomiting Diarrhea (+) cancer (-) cancer ➔​ increased frequency of bowel movements more than 2x per day with altered consistency of stools. Disorders of Intestinal Motility Classification 1.​ Acute - self-limiting 1-2 days Constipation ​ Causes: viral ➔​ Fewer than three bowel movements 2.​ Persistent - 2-4 weeks weekly or bowel movements that are ​ Causes: Drugs - antibiotics hard, dry, small or difficult to pass. (erythromycin, magnesium hydroxide) 3.​ Chronic - more than 4 weeks and return Risk factors: sporadically. ​ Pregnant women ​ Causes: ​ Post-op patient ​ Adverse effect of chemotherapy ​ Older client ​ Anti-arrhythmic drugs, ​ Note: constipation is a symptom not a antihypertensive drugs, disease but indicate motility disorder of endocrine probs. GIT ​ Malabsorption disorders (lactose intolerance) Causes: ​ Drugs - anticholinergic, antidepressants, Pathophysiology: opioids, iron preparation Pathogens (Salmonella) ​ Immobility | Ann Marie Peñafiel BSN 3F NMC 116 LECTURE invade the intestinal mucosa | inflammatory changes | smaller volume of bloody stools Clinical Manifestations: ​ Increased frequency and fluid content of stools ​ Abdominal cramps, distention ​ Borborygmus (rumbling noise caused by movement of gas through intestines) ​ Anorexia, thirst ​ Tenesmus (painful straining with a strong urge) ​ Voluminous, greasy stools - intestinal malabsorption ​ Blood, mucus, and pus in stools - colitis ​ Nocturnal diarrhea - diabetic neuropathy Assessment and Diagnostic Finding ​ Stool exam ​ СВС ​ Serum electrolytes ​ Endoscopy/barium enema Medical Management: ​ Antibiotic ​ Anti-inflammatory ​ Anti-diarrheal Nursing Management: ​ Assess and monitors the characteristics and pattern of diarrhea (history taking, abdominal auscultation, palpation, inspection) ​ Increased fluid intake and foods low in bulk ​ Avoid caffeine, alcohol dairy products, fatty foods Ann Marie Peñafiel BSN 3F NMC 116 LECTURE 2ND DISCUSSION ​ Stress management ​ Fluid should not be taken with meals Irritable Bowel Syndrome Malabsorption Syndrome ➔​ chronic functional disorder characterized ➔​ inability of the digestive system to by recurrent abdominal pain associated absorb one or more of the major with disordered bowel movements vitamins (vit. A and B12), minerals iron, (diarrhea, constipation or both. calcium) and nutrient (CHO, fats and CHON) Risk factors: ​ Women Celiac Disease (gluten sensitive enteropathy) ​ Age - below 45 years old ​ Disorder of malabsorption caused by ​ Genetic autoimmune response to consumption ​ Environment of products that contain the protein ​ Psychosocial gluten (wheat, barley, rye and other grains). Pathophysiology: ​ An autoimmune condition wherein an GUT motility problem → cause contraction that exposure to gluten causes immune leads to either diarrhea/constipation → reaction which cause inflammation in Increased Sensitivity → make gut more the small bowel responsive to normal movements or stretching, causing pain and discomfort → disruption in Predisposing Factors: brain-gut interaction → leading to ​ Sex - female miscommunication between the brain and the ​ Caucasians gut, which worsens symptoms → Low-Grade ​ Familial - first degree relatives or Inflammation Gut Microbiota Imbalance → genetics symptoms. Pathophysiology Clinical Manifestations: Autoimmune response to gluten(Gluten itself is ​ Constipation, diarrhea or both constructed with a group of proteins called ​ Abdominal pain- precipitated by eating GLIADIN and glutenin) products that is both and relieved by defecation (humoral and cell mediated)→ inflammation of ​ Bloating, abdominal distention the proximal portion of the epithelial cells of intestines (absorption of nutrients occur) → Assessment and Diagnostic Findings: small intestine become denuded→ loss of ​ Bristol Stool Form Scale - record the function → loss of ability to absorb both quality and quantity of bowel micronutrients and macronutrients → systemic movements nutritional deficits ​ Absence of structural disorders - confirmation Clinical Manifestations ​ CBC, C-reactive protein ​ Often asymptomatic ​ Colonoscopy or Endoscopy ​ FTH ​ Diarrhea Medical Management: ​ fatigue ​ Goal- relieve abdominal pain and control ​ Steatorrhea diarrhea or constipation ​ Abdominal pain, distention ​ Lifestyle modification - stress reduction, ​ Flatulence adequate sleep exercises ​ Weight loss ​ Soluble fiber -(psyllium) ​ Steatorrhea ​ Restriction of irritating foods - beans, ​ Anemia- (decrease in iron, B12, and caffeinated products, fried foods, Folate) alcohol, spicy foods, corn, wheat) ​ Dermatitis herpetiformis- is a VERY ​ Anti-diarrheal drug - Loperamide itchy blister type that can be present on ​ Antidepressant drug the elbows, knees, buttocks, or hairline. Nursing Management: ​ Bristol Stool Form Scale ​ Encouraged to eat at regular times and to avoid food triggers ​ And avoid alcohol and smoking Ann Marie Peñafiel BSN 3F NMC 116 LECTURE ○​ Gluten gel, cosmetics (lipsticks) art Supplies, modeling clay) Food to avoid With Celiac Disease: -Wheat -Barley -Triticale -Rye Structural and Obstructive Bowel Disorders Acute Abdomen ➔​ Known as "surgical abdömen" ➔​ acute onset of abdominal pain that does not have a traumatic etiology ➔​ requires surgical intervention to prevent peritonitis, sepsis and septic shock. Types of Disorders: ​ Appendicitis ​ Severe diverticulitis ​ Intestinal obstruction note: above disorders can lead to peritonitis Assessment and Diagnostic Finding Peritonitis ​ Comprehensive assessment ​ inflammation of the peritoneum (serous ​ Family history membrane lining of the abdominal cavity ​ Endoscopy (Normally, the intestinal villi and covering of the viscera) look like little finger-like projections. The villi aid in the absorption of the nutrients Causes: by increasing the surface area for ​ Bacterial infection (E. Coli, Strep) absorption. However, when Celiac ​ External sources - abdominal surgery or Disease occurs the villi are DAMAGED trauma (attacked by the immune system) and ​ Inflammation that extends from an organ they will appear FLAT. ) outside the peritoneal area ​ Endoscopic biopsy (intestinal biopsy)- villous atrophy and crypt hypertrophy Category: ​ Serologic tests - patient continues to ​ Primary peritonitis - "spontaneous consume gluten products during the test bacterial peritonitis (SBP)" ​ IgA ○​ occurs as a spontaneous ​ Anti-tissue transglutaminase bacterial infection of ascitic fluid. ○​ Ex: complication of liver or Medical Management: kidney failure, ascites ​ Note: Celiac disease is a chronic, non ​ Secondary peritonitis curable, lifelong disease. ○​ secondary to perforation of ​ No drugs that induce remission abdominal organs with spillage ​ Treatment: Refrain from exposure to that infects the sours gluten foods and other products peritoneum. ○​ e.g. perforated appendix, peptic Nursing Management: ulcer sigmoid colon, ruptured Adhere in gluten free diet organ in abdomen, abdominal ​ Foods that contain gluten containing trauma, ruptured diverticula grains: ​ Tertiary peritonitis ○​ wheat, barley, bran rye bulgur, ○​ result of a suprainfection in a graham (cakes, pastries, patient who is cookies, crackers, pasta, pizza, immunocompromised. sour cream) ○​ e.g. TB peritonitis in patient with AIDS ​ Products that contain gluten Pathophysiology Ann Marie Peñafiel BSN 3F NMC 116 LECTURE Secondary peritonitis → leakage of contents Note: fluid in abdominal cavity → from abdominal organs in the abdominal cavity pressure-restrict expansion of lungs→ due to inflammation, infection, ischemia, trauma respiratory distress or tumor perforation → bacterial proliferation → ​ Oxygen therapy edema of tissues → exudation of fluid develops ​ Antibiotics - broad spectrum antibiotics → fluid in peritoneal cavity becomes turbid → thru IV increase amounts of protein, WBC, cellular ​ Surgery debris and blood → hypermotility of intestinal tract → paralytic ileus accumulation of air and Nursing management: fluid in the bowel. ​ Intensive care - for septic shock ​ Increased fluid and food intake gradually Clinical Manifestations: - once peritonitis subsides ​ Pain is diffuse then constant, localized ​ Prepare patient for surgery and intense ​ Abdomen is tender, distended and Appendicitis muscles is rigid ➔​ Inflammation of appendix ​ Rebound tenderness ​ Anorexia, nausea and vomiting Predisposing factors: ​ Peristalsis is diminished ​ Age - 10-30 years old ​ Paralytic ileus ​ Sex - higher in male ​ Temp.37.8-38.3, increased pulse rate, ​ Familial predisposition hypotension symptoms of sepsis and septic shock Pathophysiology: Appendix is inflamed and edematous due Clinical Manifestation kinking or occlusion by fecalith → lymphoid ​ Pain is diffuse then constant, localized hyperplasia (due to inflammation or infect and intense foreign bodies (fruit seeds) ​ Abdomen is tender, distended and inflammation → increases intraluminal muscle is rigid pressure--edema and obstruction of the irifice→ ​ Rebound tenderness ischemia, bacterial overgrowth → gangrene or ​ Anorexia, nausea and vomiting perforation ​ Peristalsis is diminished ​ Paralytic ileus Clinical Manifestations: ​ Temp.37.8-38.3, increased pulse rate, ​ Vague peri umbilical pain with anorexia hypotension progresses to right lower quadrant pain ​ Symptoms of sepsis and septic shock and nausea ​ Local tenderness - MCBurney's point Assessment and Diagnostic Findings: ​ Rovsing sign - palpate the left lower ​ Increased WBC, increased in immature quadrant causes pain in the right lower neutrophils quadrant area. ​ Decreased Hgb, Hct ​ Abdominal distention - peritonitis due to ​ Altered levels in electrolytes (potassium, ruptured appendix sodium, chloride) ​ Abdominal X-ray - air and fluid, Assessment and Diagnostic Findings distended and bowel loops ​ CBC - elevated WBC and neutrophils ​ Abdominal UTZ and CT scan-abscess, ​ C reactive protein- elevated fluid, collections ​ CT scan - right lower quadrant density or localized distention of bowel Medical Management: ​ Fluid, colloid, electrolyte replacement - Complications: IVF - isotonic solutions ​ Gangrene Note: due to massive amounts of fluid and ​ Perforation of appendix - peritonitis electrolytes move from the intestinal lumen into ​ Abscess formation portal pylephlebitis - the peritoneal cavity and depletion of fluid in the septic thrombosis of portal vein due to vascular space il hypovolemia vegetative emboli that arises from septic ​ Analgesic intestines. ​ Antiemetic ​ Gerontological Considerations: ​ Intestinal intubation and suction - relieve ​ Older adults - symptoms maybe vague abdominal distension and promote → resulting to gangrene or perforation intestinal function of appendix Ann Marie Peñafiel BSN 3F NMC 116 LECTURE ​ Medications- steroids, opioids, NSAID's, Medical Management: acetaminophen ​ Stat surgery - appendectomy ​ Sedentary Lifestyle ​ Antibiotics ​ IV fluids Diverticulosis ➔​ is the formation of hollow sac Nursing Management: cavities..-throughout the intestinal wall. Goal: These outpouching sacs can form 1. Relieve pain anywhere throughout the intestine but 2. Prevent fluid volume deficit are most commonly found in the sigmoid 3. Reduce anxiety colon of the large intestine. 4. Preventing or treating and eliminating ➔​ presence of multiple diverticula without infection inflammation or symptoms. 5. Preventing atelectasis 6. Maintaining skin integrity Signs and Symptoms of Diverticulosis 7. Attaining optimal nutritional ​ Patients are usually asymptomatic until they develop a complication. If a patient Preoperative Nursing Care: does have signs and symptoms they 1. IVF - replace fluid loss and promote adequate may experience: renal function ​ change in bowel pattern (sudden 2. Antibiotic therapy-prevent infection constipation/diarrhea) 3. Analgesic for pain ​ abdominal bloating 4.Enema is contraindicated - lead to perforation ​ Mild cramping Post-operative Nursing Care: Complication of Diverticulosis: 1. High fowler position - reduces tension in Diverticular Bleeding- arterial walls of intestine incision and abdominal organ→ reduce pain. become weak overtime and rupture. - promote thoracic expansion→ diminished the ​ Painless bleeding work of breathing decreased atelectasis ​ Bright red stools 2. Incentive spirometer - every 2 hours ​ Abdominal cramping 3. Morphine - parenteral opioid 4. Start oral feeding when bowel sound are Obstruation- narrowing of colon called present strictures where stool can't pass Note: auscultation for ​ Constipation the_______________sounds or ​ Abdominal distention passing of flatus ​ vomiting 5. Monitor urine output 6. Ambulation the day of _______________ Treatment risk of atelectasis and venous _________ ​ Usually requires no treatment ​ If recurrent symptoms: Diverticular disease ○​ High fiber diet ​ Diverticulosis ○​ Fiber supplements ​ Diverticulitis ○​ Probiotics Diverticulum Diverticulitis ➔​ saclike herniation of the lining of the ➔​ Pouches becomes inflamed and bowel that extends through a defect in undigested food or stool gets trapped in the muscle layer. pouches ➔​ Form in weak spots of the colon ➔​ diverticulum becomes inflamed, causing ➔​ Small pouches that form on the perforation, and potential complications intestinal walls. (Obstruction, abscess, fistula, peritonitis, ➔​ Colon - common site hemorrhage. ➔​ complication of diverticulosis: Risk factors: ➔​ inflammation of the diverticulum...hence ​ Diet- & fiber and T red meat the herniate sacs becomes inflamed. ​ Age- over 40 years old This can lead to abscess, rupture of the ​ Smoking and alcohol abuse diverticula which leads to peritonitis and ​ Genetics sepsis. ​ Obesity Pathophysiology Ann Marie Peñafiel BSN 3F NMC 116 LECTURE ​ Mucosal and Submucosal lavers of the Nursing Management: colon →herniate through the muscular ​ Fluid intake of 2L/day wall due to (high intraluminal pressure, ​ Soft diet, high in fiber low volume in the colon and decreased ​ Exercise muscle strength in the colon wall) → ​ Daily intake of bulk of laxatives bowel contents accumulate ​ Avoid nuts and popcorn ​ In the diverticulum and decompose → inflammation and infection. and EDUCATION spasticity of the colon. DURING FLARE UP ​ Diverticulum is obstructed and ​ NO inflamed→weakened colonic wall ​ No high fiber food →perforation→ resulting in irritability ​ No solid food and spasticity of the colon. ​ Clear liquids for 2-3 days ​ Abscess develop → perforation → peritonitis → erosion of the arterial blood RECOVERY AND MAINTENANCE vessels → bleeding ​ Gradually introduce low fiber food ​ Build up to high fiber food Clinical Manifestations: ​ Psyllium supplements ​ Severe LLQ pain ​ adequate hydration ​ Bloody stools ​ Chronic constipation ​ Bowel irregularities (alternating constipation and diarrhea) ​ Nausea, anorexia ​ Bloating, abdominal distention ​ Fever and chills Signs and Symptoms P- Pain in abdomen…..mainly in the left lower quadrant O- Observe abdominal bloating - and blood in stool U- Unrelenting cramping type pain C- Constipation H- High temperature DIAGNOSTICS ​ Colonoscopy ​ Labs: T WBC and CRP ​ CT Scan- assess for abnormalities in Gl tract ​ Abdominal X-ray Medical Management: 1. Rest 2. Oral fluids - clear liquids 3. Analgesic 4. High fiber, low fat diet - increase stool volume, decrease colonic transient time and reduce intraluminal pressure. 5. Surgery (perforation, peritonitis, hemorrhage, obstruction) A). Hartmann procedures - one end of the bowel is brought out to the abdominal wall and the distal end is closed over and left in the abdomen B). double-barrel colostomies- both ends of the bowel are brought out to the abdominal wall. Ann Marie Peñafiel BSN 3F