NCM 112 Gastrointestinal Tract Lecture Notes PDF

NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract GASTROINTESTINAL TRACT For Ice Chips 100 – 200 ml:...

NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract GASTROINTESTINAL TRACT For Ice Chips 100 – 200 ml: loss of fluid If the Ice chip cup = 200, then volume recorded will be 100 mL only. This is because 8L – fluid circulates through the GI system every 24 hours you half the volume taken. Small Intestine Foods that become liquid at room temperature Most of the fluid is reabsorbed into the blood stream Ice Cream Fecal Matter Gelatin Composed of 75% fluid and 25% solid Purees are not considered solid foods Kidney Failure Common Signs and Symptoms with problems of GIT Abdominal Pain Indigestion Belching Flatulence Nausea Vomiting PAIN Can be a major sign and symptom of GI disease OLDCART PQRST o Onset o Provocation o Location o Quality / Quantity Fluid Intake: 2400 – 2700 o Duration o Region Fluid Output: 2300 -2500 o Characteristics o Severity scale *Only 100 – 200 difference between the two o Aggravating factor o Timing o Relieving factor o Treatment 1 glass = 200 mL/240 mL 1 | OSNAN, JASPER  NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract Changes in Bowel Habits and Stool Characteristics o May signal colonic dysfunction or disease o Constipation – decrease in the frequency of the stool or stools that are hard, dry, small volume than normal o Diarrhea – abnormal increase in the frequency and liquidity of the stool DYSPEPSIA (INDIGESTION) Most Common Sign and Symptom Upper abdominal discomfort associated with eating Upper abdominal or epigastric pain, discomfort, fullness, bloating, early satiety, belching, heartburn or regurgitation Causes: fatty, salads, coarse veggies, highly seasoned foods Melena – Black tarry stool INTESTINAL GAS Hematochezia – Red stool Belching (BURP) VOMITING Flatulence (FART) – not an indicator of gallbladder disease, it’s normal to have one Forceful expulsion of gastric contents through the mouth but for others, it’s not the case Preceded by Nausea Bloating, distention or feeling “full of gas” Results from coordinated sequence of abdominal muscle contractions and reverse Symptom of food intolerance or gallbladder disease esophageal peristalsis (that’s why you throw up) NAUSEA AND VOMITING Common signs of GI disorders Uncomfortable sensation of sickness or queasiness Occurs with fluid and electrolyte imbalances; infections; and metabolic, endocrine, Can be triggered by odors, activity, medications or food intake labyrinthe, central venous systems and cardiac disorders Vomitus / Emesis Can also result from drug therapy, surgery, or radiation o May vary in color and content Occurs normally during the first trimester of pregnancy, but its subsequence o May contain undigested food particles, blood (hematemesis), bilious material development may signal complications mixed with gastric juices Can also result from stress, anxiety, pain, alcohol intoxication, overeating, or ingestion of distateful foods or liquids 2 | OSNAN, JASPER  NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract Major concern in children who are vomiting Inspect, Auscultate, Palpate, Percuss o Risk for dehydration Inspect the abdomen for distention o Loss of fluid and electrolyte Auscultate for bowel sounds and bruits o Development of metabolic alkalosis (loss of hydrochloric – hydrogen ions Palpate the rigidity and tenderness, and test for rebound tenderness and increase in bicarbonate) Palpate and percuss the liver for enlargement. Assess other body systems as Additional concerns: appropriate o Aspiration Inspect, asucultate, palpate, percuss for the abdomen o Development of atelectasis or pneumonia *Projectile vomiting unaccompanied by nausea may indicate increased intracranial Vomiting Pathophysiology pressure Intestinal contents accumulating in the duodenum and stomach stimulate the vomiting *If this occurs in a patient with CNS injury, you should quickly check his vital signs. Be center in the medulla oblongata alert for widened pulse pressure or bradycardia 1. Contractions of the stomach begin to push the gastric contents into the Characteristics and Causes esophagus as the lower esophageal sphincter relaxes; When you collect a sample of the patient’s vomitus, observe it carefully for clues to the 2. Deep breath is taken and the vestibular and vocal folds close the opening of the underlying disorder larynx BILE - STAINED = Green Vomitus Obstruction below the pylorus as from duodenal 3. The hyoid bone and the larynx and elevated, opening the upper esophageal lesion sphincter BLOODY VOMITUS - Upper GI bleeding (if bright red, may result from gastritis or a 4. The soft palate elevates, closing the connection between the orophaynx and the peptic ulcer; if dark red, from esophageal or gastric varices) nasopharynx BROWN VOMITUS WITH FECAL ODOR - Intestinal obstruction or infarction 5. The diaphragm and the abdominal muscles are forcefully contracted, strongly BURNING, BITTER-TASTING VOMITUS - Excessive hydrocloric acid in gastric compressing the stomach and increasing the intragastric pressure contents 6. The lower esophageal sphincter relaxes completely; anmd COFFEE-GROUND VOMITUS - Digested blood from slowly bleeding gastric or 7. The gastric contents are forced out of the stomach, through the esophagus and duodenal lesion oral cavity, to the outside UNDIGESTED FOOD History and Physical Examination Describe the onset, duration and intensity of the vomiting Explore any associated complaints, nausea, abdominal pain, anorexia and weight loss, changes in bowel habits or stools Obtain a medical history, noting GI, endocrine and metabolic disorderws, recent infections and cancers, including chemotherapy or radiation therapy Ask about the current medication use and alcohol consumption If patient is a female of chilbearing age, ask if she is or could be pregnant. Ask which contraceptive method she’s using 3 | OSNAN, JASPER  NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract Vomiting Interventions For Interventions: 1. Maintain a patent airway 1. Fluid and electrolytes must be replaced IV when gastric suction or continuous 2. Position the child on the side to prevent aspiration drainage is ordered 3. Monitor the character, amount and frequency of vomiting 2. Irrigate before and after feedings or the instillation of medication (15-30ml of flushing) 4. Assess the force of the vomiting; projectile vomiting may indicate pyloric stenosis or 3. Offer mouth care every 2 hours increased intracranial pressure 4. Avoid tension and pulling on the tube 5. Monitor strict intake and output 5. Maintain suction ordered by the physician 6. Monitor for signs and symptoms of dehydration, such as sunken fontanel (age- 6. Report an increasing amount of bloody drainage (the tube might have been appropriate), non elastic skin turgor, dry mucous membranes decreased tear perforated on the stomach or suctioned into a gastric or duodenal ulcer) production, changes in vital signs, and oliguria (use tongue turgor for older adults) Imbalance associated with Gastric Juice (Vomiting or Suction) 7. Monitor electrolyte levels Fluid volume deficit (hypovolemia) 8. Provide oral rehydration therapy as tolerated and as prescribed; begin feeding slowly, Metabolic alkalosis with small amounts of fluid at frequent intervals o Loss of acid because it was vomited or suctioned 9. Administer antiemetics o Amount of bicarbonate exceeds the normal 20:1 ratio of hydrogen and bicarb 10. Assess for abdominal pain or diarrhea Potassium deficit (hypokalemia) 11. Advise the parents to inform the primary health care provider (PHCP) if signs of Sodium deficit (hyponatremia) dehydration, blood in the vomitus, forceful vomiting, or abdominal pain is present DIARRHEA GASTRIC / INTESTINAL DECOMPRESSION / LAVAGE Increased frequency of bowel movements (>3x/day) A procedure meant to empty stomach of toxic substances Increased amount of stool (>200g/day) Gastric intestinal tubes attached to some clients after surgery and ordered to be Altered consistency of stool (increase liquidity) connected to a suction Contents move so rapidly through the intestine - inadequate time for the GI secretions Suctioning can be intermittent or continous to be absorbed Food poisoning Small intestine absorbs water and nutrients Purpose: Caused by: o To relieve abdominal distention o Altered Motility – frequency of the bowel movement o To maintain gastric decompression after surgery o Intestinal secretion o To remove blood and secretions from the GIT o Mucosal absorption o To relieve discomfort (bowel obstruction) Medications o To maintain patency of the NGT (suction on a low pressure) o Tube feeding formulas Common gastrointestinal suction tubes o Metabolic and endocrine disorders o Viral or bacterial infectious processes 4 | OSNAN, JASPER  NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract Classification of Diarrhea Infectious Acute Persistent o Results from infectious agents invading the intestinal mucosa Usually self limiting 2 -4 weeks o Clostridium difficile – most commonly identified agent in antiobiotic – associated Lasts between 1 – 2 days Frequently caused by viral infections diarrhea Frequently caused by viral infections Meds: antibiotics and magnesium  Bacteria that causes diarrhea and colitis Meds: Antibiotics and magnesium containing antacids Exudative containing antacids o Caused by changes in the mucosal integrity, epithelia loss or tissue Chronic destruction by radiation or chemotherapy More than 4 weeks and may return sporadically  Together with secretory Caused by: adversed effects of chemotherapy, antiarrhythmic agents, Clinical Manifestations of Diarrhea antihypertensive agents, metabolic and endocrine disorders, maladaptive disorders, Abdominal cramps, distention anal sphincter defect, Zollinger-Ellison syndrome, AIDS and by parasitic or Borborygmus – rumbling noise caused by movement of gas through the intestines Clostridium infections Anorexia, thirst Zollinger-Ellison Syndrome = Excess of gastric juice in the stomach Painful spasmodic contraction of the anus Tenesmus (Ineffective, sometimes painful straining with a strong urge to defecate) Types of Chronic Diarrhea (SOMIE) According to stool Secretory Watery stool – small bowel o High volume Semi-solid stool – large bowel is affected o Associated w/ bacterial toxins and chemotherapeutic agents used to treat o The small bowel already absorbed but not absorbed by the large intestine neoplasms Intestinal malabsorption – voluminous, greasy stools o Caused by increased production and secretion of water and electrolytes by the Inflammatory enteritis/colitis – presence of blood, mucus, pus intestinal mucosa into the intestinal lumen Pancreatic insufficiency – oil droplets on the toilet water Osmotic Diabetic neuropathy – nocturnal diarrhea (waking up at night to urinate) o When water is pulled into the intestine by the osmotic pressure of unabsorbed Clostridium difficile infection – unexplained diarrhea who are taking antibiotics particles, slowing the absorption of the water Diagnostic findings o Caused by lactase deficiency, pancreatic dysfunction of intestinal CBC count, Serum Chem, Urinalysis, Routine stool exam hemorrhage Stool exam for infetious or parasitic organisms, bacterial Malabsorptive Toxins, blood, fat, electrolytes and white blood cells o Combines mechanical and biochemical actions, inhibiting effective Endoscopy or barium enema absorption of nutrients Complications: o Low serum albumin levels lead to intestinal mucosa swelling and liquid stool Dehydration – most comon complication of diarrhea o Potassium loss – cardiac dysrythmia, muscle weakness Metabolic acidosis – loss of bicarbonate 5 | OSNAN, JASPER  NCM 112 – Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response 4F – D: Gastrointestinal Tract These findings must be reported: Imbalances associated with gastric juice loss (Diarrhea) Urinary output