Promoting Health in Patients with GI Disorders - FA24 NR710 Module 1

Promoting Health in Patients with GI disorders KAYL A GALL AGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing management of selected disorders of the g...

Promoting Health in Patients with GI disorders KAYL A GALL AGHER, MSN, RN, CNE FRANKLIN PIERCE UNIVERSITY Objectives Correlate clinical manifestations with pathophysiological process of selected gastrointestinal disorders Discuss the medical and nursing management of selected disorders of the gastrointestinal system Develop a teaching plan for a patient with gastrointestinal disorders. Discuss potential diagnostic procedures for patients experiencing gastrointestinal disorders A&P Review Oral cavity Pharynx Esophagus Stomach Small intestines Large intestines Rectum Pancreas Liver Gallbladder A&P review A&P review A&P review  Anatomy Food molecule/content Mouth Carbohydrates, fat Digestion Stomach Carbohydrates, fat, review protein Small Carbohydrates, fat, intestine protein, nucleic acids Intestinal conditions Irritable bowel syndrome (IBS) Irritable bowel disease (IBD) o Crohn's disease o Ulcerative colitis Bowel obstruction Diverticulitis Irritable bowel syndrome (IBS) Presence of abdominal pain/discomfort with altered bowel habits without any other causative disease Risks o Females > males o Ages 15-49 o Family history o Emotional stress o Food sensitivities Manifestations o Cramping, abdominal pain, bloating, distention, gas, diarrhea and/or constipation, mucous or bloody stools Treatment o Lifestyle and dietary modifications o Ensure adequate hydration o Diarrhea: probiotics, loperamide o Constipation: fiber supplements, laxatives Low FODMAP diet Elimination phase o Avoid all high-FODMAP foods Reintroduction phase o After 2-4 weeks o Systematically add foods back in Maintenance phase o Keep what works for you and leave what doesn't Crohn's disease Type of inflammatory bowel disease Causes inflammation to the deeper layers of structures lining the gastrointestinal organs between mouth and anus Patches of inflammation followed by patches of healthy tissue Relapsing and remitting course Manifestations: diarrhea, rectal bleeding, abdominal pain (RLQ), flatulence, bloating, decreased appetite, fatigue Progression of illness: abscesses, fistulas around anus Association with smoke exposure/active smoking and antibiotic us Crohn's disease Complication o Anemia o Stricture formation o Fistula o Abscesses o Colorectal cancer o Osteoporosis Treatment o Mild to moderate disease: PO mesalamine, immunomodulators, methotrexate, steroids o Moderate to severe: immunomodulators, biologics o Surgical: colectomy Ulcerative colitis Type of inflammatory bowel disease Affects colon and rectum Continuous pattern of small sores or ulcers of the superficial mucosa and submucosa that lines colon and rectum Manifestations: bloody diarrhea, fecal urgency, fatigue, increased bowel movements, mucous in stool, nocturnal bowel movements, abdominal pain, malaise, weight loss Association with past bacterial or viral infection and developing UC Ulcerative colitis Complications o Colorectal cancer o Abscess o Fistulas o Incontinence o Toxic megacolon Treatment o Initially: suppository, enema, PO (mesalamine) o Corticosteroids (supp or PO) o Probiotics to help maintain remission o If doesn’t work... biologics o Surgical § Colectomy (curative) Bowel obstruction Blockage in the small or large intestines that keeps food or liquids from passing through Manifestations: sharp or cramping abdominal pain, bloating, distention of the abdomen, diarrhea, inability to pass gas or stool, loss of appetite, N&V Association with past abdominal surgery, IBD, cancer Partial treatment – laxatives and dietary changes Complete treatment – IVF, NG for decompression, meds for nausea and pain, surgery Bowel obstruction Diverticulosis Diverticula most frequently present in sigmoid colon Areas of weakness in the intestinal tract If it becomes inflamed or infected = diverticulitis Diverticulosis develops with age Associated with: obesity, smoking, lack of exercise, low fiber, high fat diet, and medications o Medications: steroids, opioids, NSAIDs Diverticulitis Infection or inflammation of diverticula Manifestations: abdominal pain, N&V, fevers, abdominal pain, constipation or diarrhea Complications: abscess, blockage, fistula, peritonitis, perforation, sepsis Treatment o Outpatient or inpatient o Bowel rest, increased fluid intake (PO or IV if inpatient), antibiotic, pain management Diagnostic test: colonoscopy Flexible fiberoptic tube inserted into the colon Assesses entire colon Ability to visualize, take biopsies, remove polyps, etc Bowel prep prior (varies by situation, patient, and provider) Typically, sedation used Cardiac and respiratory monitoring throughout Diagnostic test: sigmoidoscopy Visualizes rectum and sigmoid Useful if cannot tolerate prep, sedation, severe inflammation of colon, or only need to visualize the sigmoid Typically, no sedation Capsule endoscopy Client swallows pill that is a camera Camera will visualize the GI tract Takes 2 pictures every second for 8 hours Bowel prep before and NPO before and 2 hours after Data retriever stays with the patient What labs do you think will be ordered for each type of intestinal disorder? What will be included in your assessment?  Let's review: fiber supplement Drug example:​ Psyllium (Metamucil) Action:​ Stool bulking agent that absorbs liquid from intestines and causes stools to be bulker Use: Diarrhea and constipation Adverse reactions:​ Diarrhea, abdominal pain, nausea, vomiting, skin rash, itching Client instructions:​ Dissolve powder in 8 oz of fluid May take ~2 days to see bowel movement Eat high fiber diet Drink extra fluids Contraindications/ Dysphagia, GI blockages precautions:​  Let's review: laxatives Drug example:​ Magnesium hydroxide (Milk of Magnesia); polyethylene glycol (Miralax) Action:​ Increases bulk of the bowel movements and helps retain fluid Use: Constipation Adverse reactions:​ Diarrhea, abdominal bloating Client instructions:​ Dissolve powder in 8 oz of fluid May take ~2 days to see bowel movement Eat high fiber diet Drink extra fluids Contraindications/ GI blockages precautions:​  Let's review: corticosteroids (GI specific) Drug example:​ Prednisone Action:​ Reduces inflammation in the intestinal lining Use: IBD flare up Adverse reactions:​ Headache, easy bruising, increased facial hair, leg edema, fatigue, changes in appetite, lightheadedness, N&V, changes in menstruation, infection, fluid retention, personality changes, hypokalemia, hyperglycemia Client instructions:​ Take in morning, full glass of water, monitor for s/s infection, do not take in same timespan as live vaccine, Contraindications/ Osteoporosis, infections, uncontrolled hyperglycemia, diabetes precautions:​ References ATI Engage Medical-surgical: Alterations in digestion and bowel elimination ATI Medical-surgical nursing: chapters 46, 47, 48, 51 ATI Pharmacology: chapter 28 29 National library of medicine: StatPearls