Nursing Care of Gastrointestinal Problems PDF

Nursing Care of Gastrointestinal Problems Prepared By: Fatima Aryan, RN, MSN, CNS  Disorder That Affect Eating Nausea and Vomiting Nausea and vomiting are common and often coexisting problems. If thes...

Nursing Care of Gastrointestinal Problems Prepared By: Fatima Aryan, RN, MSN, CNS  Disorder That Affect Eating Nausea and Vomiting Nausea and vomiting are common and often coexisting problems. If these symptoms are prolonged: Weakness, Weight loss, Nutritional deficiency, Dehydration, Electrolyte and acid-base imbalances may result  Etiology Some common causes of nausea and vomiting are: Drugs, Infections and inflammatory conditions of the GI tract, Intestinal obstruction, Systemic infections, Lesions of the central nervous system, Food poisoning, Emotional stress, Early pregnancy, Uremia  Assessment Findings 1.The client describes an unpleasant feeling, identified as nausea usually associated with loss of appetite and refusal to eat. 2.The client who experiences excessive fluid loss (dehydration) with vomiting may complain of excessive thirst and report decreased or no urine production. 3.Eyes and oral mucosa appear dry or dull, and poor skin turgor reflects fluid loss 4.The client's history may include ingestion of noxious substances, – such as excessive amounts of alcohol, contaminated food, or drugs that can cause GI side effects 5.When vomiting is secondary to intestinal obstruction, the abdomen distended, tender, and firm. to touch..Bowel sounds may be absent or hypoactive  Hernia A hernia is a protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained. Hernias that easily return to the abdominal cavity are called reducible. Types of Hernia  The inguinal hernia is the most common type of hernia An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. occurs at the point of weakness in the abdominal wall where the spermatic cord in men and the round ligament in women emerge. Femoral hernia Occurs when there is a protrusion through the femoral ring into the femoral canal. It occurs below the inguinal ligament as a bulge. It becomes strangulated easily and /occurs more often in women  Hiatal Hernia Hiatal hernia is herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm. It is also referred to as diaphragmatic hernia and esophageal hernia. However, it is the most common abnormality found on x-ray examination of the upper GI tract. Hiatal hernias are common in older adults and occur more often in women than in men. Types of hiatal hernia 1.Sliding: – The stomach "slides" into the thoracic cavity when the patient is supine and usually goes back into the abdominal cavity when the patient is standing upright. – This is the most common type of hiatal hernia.  2.Para esophageal or rolling: – The esophagogastric junction remains in the normal position, but the fundus and the greater curvature or the stomach roll up through the diaphragm forming a pocket alongside the esophagus Hiatal hernia increases with age. associated with weakening of the diaphragm, obesity, kyphosis, or other factors (e.g., wearing girdles) that increase intraabdominal pressure. Ventral or incisional hernias: Are due to weakness of the abdominal wall at the site of a previous incision. They occur most commonly in patients who are: Obese Have had multiple surgical procedures in the same area, Have had inadequate wound healing because of poor nutrition or infection.  Management (hernia) Diagnosis is based on history and physical examination findings. Herniotomy (excision of the hernia sac). Surgery the treatment of choice for hernias and prevents strangulation. Treatment of hernias is by laparoscopic surgery. The surgical repair of a hernia is known as a herniorrhaphy The reinforcement of the weakened area with wire, fascia, or mesh is known as a hernioplasty. Strangulated hernias are treated immediately with resection of the involved area or a temporary colostomy so that necrosis and gangrene do not occur. Some patients with hernias wear a truss , ‫رباط‬a pad placed over the hernia and held in place with a belt.  Disorder of the esophagus Esophagitis Gastro Esophageal Reflux Disease Esophageal cancer Esophageal diverticula Achalasia: a condition in which the muscles of the lower part of the esophagus fail to relax, preventing food from passing into the stomach Barrett's esophagus: is a change in your cells lining your esophagus (food tube). It's more common in people with acid reflux (GERD)  Esophagitis Is an Inflammation of the lining of esophagus.If left untreated this condition can become very uncomfortable , causing problems with swallowing , ulcer and scarring of the esophagus. Causes: o Bacteria o Virus o Fungal o Disease that weaken the immune system (DM) o Irritant of esophagus (vomiting , surgery, radiation, gastroesophageal reflex). Gastro Esophageal Reflux Disease(GERD) is common disorder that develop when gastric content flow upward into esophagus. GERD Is the most common upper GI problem seen in adult. Etiology : ▪ GERD result from an inability of lower esophageal sphincter close properly. ▪ Obesity and pregnancy.  Gastro Esophageal Reflux Disease(GERD) Clinical Manifestations Heartburn (pyrosis) is the most common clinical manifestation Dyspepsia ( epigastric pain ) Hyper salivation Respiratory symptoms (coughing and dyspnea) Gastric symptoms ( nausea , vomiting , bloating post meal) Non-cardiac chest pain  Complication Esophagitis Repeated exposure may cause scar tissue formation Barrett esophagus (esophageal metaplasia ) Respiratory complication (cough , bronchospasm , laryngospasm) Diagnostic studies: Barium swallows Endoscopy Biopsy and cytological specimens  Nursing management Educate the client with GERD about diet and lifestyle change to reduce reflux symptoms( alcohol , caffeine, high fat diet ) Additional measure including losing weight , elevating head of bed , stopping smoking and avoid food or drink for several hour before bedtime. Teach the client about medication to control reflex Teach the client about the importance of controlling sever GERD to prevent complication. Encourage the patient to eat small frequent meals to prevent gastric distention Explain the rational for high protein low fat diet Teach the patient not to lie down for 2-3 hr after eating Care plan  Nursing Management (vomiting) Obtain a complete medical, dietary , drug, and allergy history In addition, a list of symptoms that occurred before and along with nausea and vomiting, how long problem has existed, and frequency color, and amount of vomited material. In addition, assess general appearance, weight, and signs Documenting intake and output and monitoring for signs fluid volume deficit are additional essential assessment requirements. Offer clear fluids in small amounts to help the client develop tolerance and determine if he or she can. advance the diet.  Recommend commercial over-the-counter beverages, which replace fluids and electrolytes Inform the physician if urine output is below 500mL/ day or serum electrolyte levels are abnormal. These findings Indicate severe dehydration and need for IV replacement fluids. Monitor the client's weight daily to determine trends in weight loss or gain Assess skin turgor and mucous membranes for any signs of dehydration. When the client tolerates clear fluids, advance diet in full liquids, then to soft, bland foods such as creamed soups, or toast. Discourage caffeinated or carbonated beverages, which may decrease appetite The truss ( ‫ )رباط‬is worn to keep the hernia from protruding, if a patient wears a truss, the nurse should check for skin.  Nursing management (hernia) Irritation caused by the continual rubbing of the truss against the skin After a hernia repair, the patient may have difficulty voiding. Therefore the nurse should observe for a distended bladder. An accurate intake and output record is important. Scrotal edema is a painful complication after an inguinal hernia repair. A scrotal support with application of an ice bag may help relieve pain and edema Coughing is not encouraged, but deep breathing and turning should be done. If the patient needs to cough or sneeze, the incision should be splinted during coughing, and sneezing, should be done with the mouth open. After discharge the patient may be restricted from heavy lifting for 6 to 8 weeks.